系统性红斑狼疮伴癔病样发作一例

<正>患者女,28岁,主因乏力、纳差、面色苍白3月余,红斑1个月余,间断胡言乱语4 d于2009年12月21日入院。2009年9月初无明显诱因出现乏力、纳差、面色苍白,伴活动后心悸,就诊于当地市级医院,查血常规:白细胞2.9×     

类风湿关节炎患者外周血T淋巴细胞亚群与临床相关性分析

目的 探讨类风湿关节炎(RA)患者外周血T细胞亚群的变化情况,了解其变化在RA发病及炎症活动中的意义.方法 采用流式细胞仪荧光抗体标记法分别对197例RA患者的外周血淋巴细胞进行CD3/CD8/CD45/CD4及CD3/CD16+56/CD45/CD19四色荧光抗体(B.D)标记,分析比较RA患者外周血淋巴细胞比例情况,并与RA疾病活动性评分(DAS28-4)、压痛关节数、肿胀关节数、晨僵时间、医生和患者对疼痛程度的视觉模糊评分(VAS)、血红细胞沉降率、C反应蛋白及血清学抗体行相关分析.结果 RA患者外周血淋巴细胞中CD3+CD19-、CD3+CD4+和CD3+CD8+T细胞占总淋巴细胞的百分率分别为(71.06±12.07)%、(45.13±36.14)%和(26.56±9.54)%,RA患者CD3+CD19-T细胞与DAS28-4、压痛关节数、肿胀关节数及患者VAS存在负相关(P<0.05).RA患者外周血CD3+CD4+T(Th)淋巴细胞与抗环瓜氨酸肽抗体呈明显负相关(r=-0.156,P=0.029),与抗角蛋白抗体、人抗核周因子抗体、类风湿因子无明显相关.合并肺间质病变组与未合并肺间质病变组T细胞和Ts细胞差异有统计学意义(Z=-2.159和-2.031,P=0.031和0.042),合并干燥综合征组与未合并干燥综合征组的免疫功能差异无统计学意义(P>0.05).结论 RA思者外周血T淋巴细胞存在比例的失衡,T淋巴细胞数量的异常可能是RA发病及炎症活动的重要影响因素.

Abstract：

Objective To study the change of T cell subsets in peripheral blood of patients with rheumatoid arthritis (RA) and investigate the significance of T cell 1 subsets change in the incidence and inflammatory activity of RA. Methods Four-color fluorescence flow cytometry was used to detect the CD3/CD8/CD45/CD4 and CD3/CD16 +56/ CD45/CD19 markers in the peripheral blood lymphocytes of 197 RA patients. The proportion of peripheral blood lymphocytes in RA patients was compared and correlation analysis was conducted between T cell subsets and disease activity indices which include disease activity score(DAS28-4) ,tender joint count (TJC) .swollen joint count(SJC) , time of morning stiffness, patient's global assessment of disease activity on a 100 mm VAS by doctor and patients, erythrocyte sedimentation rate, C-reactive protein and serum antibody. Results The proportions of CD3+CD19- , CD3+ CD4+ and CD3+ CD8+ T cells in peripheral lymphocytes were (71.06 ±12.07)% , (45.13 ±36.14)% and (26.56 ±9.54)% respectively in RA group. Correlation analysis indicated significant negative correlations of the proportions of CD3+ CD19- cells with DAS28-4, TJC, SJC and patient's global assessment of disease activity a 100 mm VAS by patients (P <0.05 ). Furthermore, CD3+ CD4+ T cells still showed significant negative correlation with the anti-CCP antibody (r =-0. 156,P =0. 029) , and no correlation with AKA, APF and RF. CD3+ CD19-and CD3+CD8 + T cells showed significant differences between the interstitial lung disease group and control group (Z=-2. 159 and -2.031, P= 0. 031 and 0.042). There was no significant difference between the Sj(o)gren' s Syndrome group and control group(P>0.05). Conclusion The proportion of T lymphocytes in peripheral blood of patients with RA and the abnormality of T lymphocytes may play an important role in the incidence and inflammatory activity of RA.     

系统性红斑狼疮合并脑积水一例

患者女,24岁,因皮疹4年,面部蝶形红斑2年,间断头痛、口角抽搐、意识丧失5个月于2009年8月24日入院。2005年4月出现全身散在皮疹,不高出皮面,皮疹愈合后留有色素沉着,伴瘙痒,无发热、关节肿痛。     

晚发系统性红斑狼疮患者外周血CD4+T细胞亚群水平变化及临床意义

目的探讨晚发SLE患者外周血CD4+T细胞亚群水平及其临床意义。方法收集2016年1月至2021年12月就诊于山西医科大学第二医院风湿免疫科的260例初诊SLE患者临床资料, 其中晚发SLE(发病年龄≥50岁)58例, 普通SLE(18岁≤发病年龄≤49岁)202例。并收集同期健康体检者160名为健康对照, 其中年龄50～85岁者35名为健康对照1组, 年龄18～49岁者125名为健康对照2组。采集所有患者和健康对照者外周血, 流式细胞术检测外周血CD4+T细胞亚群。采用SPSS 22.0统计软件进行χ2检验或Mann-WhitneyU检验比较组间差异。结果 (1)与普通SLE患者相比, 晚发SLE患者确诊所需时间延长[5.0(2.0, 24.0)个月和3.0(1.0, 7.3)个月, Z=-3.13, P=0.002], 疾病活动度SLEDAI评分降低[12.0(8.0, 15.2)分和14.0(10.0, 18.0)分, Z=-2.12, P=0.034]。晚发SLE患者更易出现体质量减轻、恶心、腹痛, 更易并发脑梗死、间质性肺炎、干燥综合征和感染, 而皮肤黏膜受累相对少见。(2)...