Menstrual and Reproductive Characteristics of Patients with Primary Sjogren’s Syndrome:A 7-year Single-center Retrospective Study

Objective Primary Sjogren’s syndrome(pSS)is a systemic autoimmune disease that mainly affects the exocrine gland,especially in women.Currently,the results of studies on the menstruation or fertility of pSS patients remain controversial.This study aimed to examine the menstrual and reproductive characteristics of pSS patients.Methods Clinical data of 449 pSS patients who were admitted to Tongji Hospital in Hubei,China,from January 2015 to November 2021 were obtained and their menstrual and reproductive information analyzed.In addition,the clinical features of pSS patients with premenopausal or postmenopausal onset were compared.Results The spontaneous abortion rate of pSS patients was not higher than the reported rate of the general population and that the age of menarche,menstrual cycle,and menstrual period of pSS patients did not significantly differ from those reported in the general population;however,early menopause seemed to be more common in pSS patients.Skin involvement(27.96%vs.15.00%,P=0.005)and hyperglobulinemia(10.64%vs.4.16%,P=0.033)were more common in patients with premenopausal pSS onset,but patients with postmenopausal onset had a significantly greater incidence of interstitial lung disease(32.50%vs.17.02%,P=0.0004).Also,erythropenia(47.00%vs.31.25%,P=0.002),hypoalbuminemia(19.49%vs.8.22%,P=0.0009),and prevalence of high hypersensitive C-reactive protein levels(21.67%vs.10.94%,P=0.005)were more common in pSS patients with postmenopausal onset.Notably,the rate of abnormal pregnancy was significantly greater in patients with premenopausal onset(9.72%vs.2.50%,P=0.011).Conclusion Patients with pSS onset before or after menopause may have different risks in pulmonary involvement and laboratory manifestations.

A Case of Podocytic Infolding Glomerulopathy with Primary Sjogren's Syndrome and Hashimoto's Thyroiditis

To the Editor:Podocytic infolding glomerulopathy (PIG)was proposed as a new disease entity in 2008,[1] and great attention has been paid to PIG because of the rare pathological changes to glomeruli associated with it.PIG is characterized by specific changes to the thickened glomerular basement membrane (GBM), including microspheres,microtubular structures,and podocytic infolding.However,the clinical features and pathogenesis of PIG still remain unclear.To elucidate the characteristics of this glomerulopathy,accumulating more information from reported cases is necessary.Herein,we present a case of glomerulopathy showing podocytic infolding in association with primary Sjogren's syndrome (pSS)and Hashimoto's thyroiditis.

原发性干燥综合征41例CNS临床特点分析

目的探讨CNS原发性干燥综合征(CNS-pSS)的CNS病变临床特点。方法回顾性分析41例CNS-pSS患者的临床症状、影像学结果、治疗方案及预后相关资料,总结其临床特点。结果CNS-pSS发生率为2.35%,0.4%的患者以CNS病变为首发表现,复发率38.89%。CNS-pSS常见临床症状为头晕、头痛、肢体无力、感觉异常、言语障碍、视力下降等。影像学上脑和脊髓均可受累,以多发性病灶为主(85.37%)。脑部病变以脑室旁白质、额叶顶叶T_(1)低信号,T_(2)、Flair高信号,DWI等/高信号为主。脊髓病变以长节段脊髓病灶为主。95.12%的患者抗核抗体滴度升高,抗核抗体滴度≥1∶1000者占36.59%。96.67%(29/30)的患者CSF化验异常,以白细胞数升高和/或蛋白升高为主,6例患者CSF检测水通道蛋白4抗体,4例阳性。61.11%的患者经糖皮质激素及免疫治疗后临床症状缓解。平均随访3.2年,38.89%的患者临床复发,其中脊髓病变复发风险更高。结论CNS-pSS临床症状复杂,发病率低复发率高,影像学特征为头颅/脊髓多发性类脱髓鞘病灶。抗核抗体滴度、抗干燥综合征A抗体、CSF检查对诊断具有重要意义。糖皮质激素联合免疫抑制治疗可缓解大部分患者的临床症状。

干燥综合征继发肺间质病变患者检测血浆D-二聚体和纤维蛋白（原）降解产物的临床意义

目的：探讨原发性干燥综合征（pSS）继发肺间质病变（ILD）患者血浆D-二聚体（DD）和纤维蛋白（原）降解产物（FDP）的水平变化及其临床意义。方法检测2011年～2013年住院的42例pSS-ILD患者与同期42例无ILD的pSS患者血浆DD、FDP、血沉（ESR）、C反应蛋白（CRP）、类风湿因子（RF）和免疫球蛋白G（IgG）水平，用两样本t检验和相关性分析进行统计学分析。结果 pSS-ILD组DD、FDP、ESR、CRP、RF和IgG检测结果分别为（864.56±235.82）ng/mL、（6,710.70±564.58）ng/mL、（72.39±12.67）mm/h、（55.94±13.18）mg/L、（54.78±8.02）U/mL和（23.50±4.21） g/L，较无ILD的pSS组（165.00±25.41）ng/mL、（2,760.29±382.46）ng/mL、（45.91±11.35）mm/h、（21.19±12.50） mg/L、（30.98±9.24）U/mL和（12.88±6.04）g/L高，差异有统计学意义（均P＜0.05）。DD和FDP与ESR、CRP均呈直线正相关（r=0.992、0.996和0.923、0.935，均P＜0.01），两者与RF也呈直线正相关（r=0.553，0.509，均P＜0.05）。DD和FDP与IgG无直线正相关（r=0.235，0.361，均P〉0.05）。结论 pSS-ILD患者体内存在高凝状态，DD和FDP可作为临床判断pSS继发ILD患者的病情活动的非特异性炎性反应指标。

Focus on Effects of Chinese Medicine on Improving Anxiety-Depression and Quality of Life of Patients with Primary Sjogren’s Syndrome

Primary Sjogren’s syndrome(pSS)is a chronic autoimmune disease with a long duration of illness,for which there is no cure.Patients often suffer from anxiety and depression due to various reasons,exhibiting a decline in their quality of life.Chinese medicine(CM)has certain advantages in the treatment of pSS,which not only helps relieve clinical symptoms and improve treatment outcomes,but also reduces anxiety and depression and improves the quality of life.Therefore,CM should be considered as early as possible given its effectiveness and synergistic effects in treating p SS.

Challenges in Treatment of Primary Sjogren’s Syndrome and Opportunities for Chinese Medicine

Primary Sjogren’s syndrome is a chronic autoimmune disease that can lead to systemic manifestations.At present,immunomodulatory agents have not shown good efocacy,many patients in China seek Chinese medicine treatment.Chinese medicine can comprehensively improve the symptoms of patients through Chinese pattern diagnosis and individualized treatment.Fundamental researches are providing scientioc bases for the therapeutic effect of Chinese medicine.Professional Chinese medicine treatment can be integrated into the conventional management of primary Sjogren’s syndrome.

中医辨证治疗老年原发性肾病综合征的效果分析

目的:分析对老年原发性肾病综合征患者进行中医辨证治疗的效果。方法:回顾性分析淮安市淮阴医院肾内科2017年1月至2019年12月收治的20例老年原发性肾病综合征患者的临床资料。将其随机分为对照组和观察组,每组各有患者10例。两组患者均采用糖皮质激素进行治疗(治疗时间为12周),在此基础上对观察组患者进行中医辨证治疗。比较两组患者治疗后的24 h尿蛋白定量、血浆白蛋白的水平及不良事件的发生率。结果:治疗4周后、8周后及12周后,观察组患者的24 h尿蛋白定量均低于对照组患者,差异有统计学意义(P<0.05)。治疗8周后及12周后,观察组患者血浆白蛋白的水平均高于对照组患者,差异有统计学意义(P<0.05)。随访期间,观察组患者不良事件的发生率低于对照组患者,差异有统计学意义(P<0.05)。结论:在用糖皮质激素对老年原发性肾病综合征患者进行治疗的基础上,对其实施中医辨证治疗能有效减少其尿蛋白,改善其血浆白蛋白的水平,降低其不良事件的发生率。