大疱性类天疱疮合并其他免疫性疾病研究进展

大疱性类天疱疮可合并多种免疫性疾病,如免疫性皮肤病（银屑病、白癜风、斑秃及多种其他免疫性疱病）、消化系统免疫性疾病（炎症性肠病、原发性胆汁性肝硬化）、自身免疫性甲状腺疾病、风湿免疫病（类风湿性关节炎、皮肌炎、硬皮病及系统性红斑狼疮）、泌尿系统免疫性肾脏病（免疫性肾病、肾移植排斥）及A型获得性血友病等,明显影响了患者的生...     

结缔组织疾病

20062066系统性红斑狼疮和类风湿性关节炎T细胞异常调节与免疫功能紊乱的研究/王兰兰(四川大学华西医院室验医学科临床免疫实验室),蔡蓓,冯伟华…∥检验医学.-2006,21(2).-95~99采用流式细胞术检测系统性红斑狼疮SLE、类风湿性关节炎RA患者作外周血T细胞亚群表达CD28、CD152、诱导性共刺激因子(ICOS)、CD154、CD30和CD95分子表达。结果发现:与健康对照比较,SLE和RA患者组分别为CD3 CD8 T细胞和CD3 CD4 T细胞增加(P<0·05),SLE患者CD4 T细胞和CD8 T细胞上CD28和CD152分子表达率增加,ICOS分子表达减少(P均<0·05),CD15…     

系统性红斑狼疮和类风湿性关节炎中类固醇激素和细胞因子间相互作用的模式

系统性红斑狼疮是以分泌辅助性T细胞 2型细胞因子为主 ,介导体液免疫反应的自身免疫性疾病 ,而类风湿性关节炎是以分泌辅助性T细胞 1型细胞因子为主 ,介导细胞免疫反应损伤的疾病。类固醇激素睾酮、脱氢表雄酮、硫酸脱氢表雄酮有促进辅助性T细胞 1型细胞因子分泌的作用 ,而雌二醇有增强辅助性T细胞 2型细胞因子分泌的作用 ;类固醇激素在系统性红斑狼疮和类风湿性关节炎发病机制中起着重要的作用。     

系统性红斑狼疮与甲状腺疾病

系统性红斑狼疮是一种异质性强的自身免疫性疾病，血清中产生以抗核抗体为代表的多种自身抗体，可引起全身器官及系统损害，患者死亡的原因主要为肾衰竭、狼疮脑病和严重感染。伴发甲状腺疾病虽然不是患者死亡的主要原因，但其发病率越来越高，研究系统性红斑狼疮与甲状腺疾病的相关性有助于加深对系统性红斑狼疮疾病特征的认识，提高患者预后。该文就系统性红斑狼疮与甲状腺疾病作一综述。     

制备小鼠肝细胞核用于免疫荧光检查抗核抗体的改良方法

作者用一改良方法制备小鼠肝细胞核,对60例不同种类疾病的患者(其中系统性红斑性狼疮17例,类风湿性关节炎27例,其他自身免疫性疾病及     

013血清B淋巴细胞刺激物水平在系统性免疫性风湿性疾病患者中是升高的

该研究的目的是明确在系统性免疫性风湿性疾病患者中 ,血清Ｂ淋巴细胞刺激物 (ＢＬｙＳ)的水平是否升高及其与血清免疫球蛋白 (Ｉｇ)和 (或 )自身抗体滴度的关系。方法 :从 185例患者中取血清 ,其中95例患系统性红斑狼疮 (ＳＬＥ) ,6 7例患类风湿性关节炎 (ＲＡ) ,2 3例患其他系统性免疫性疾病。对 7例需接受关节穿刺术的患者 ,同时测定其滑膜液ＢＬｙＳ水平。从 4 8例健康者中取血清作对照。结果 :185例患者中 ,38例的血清ＢＬｙＳ水平升高 ,并且和血清ＩｇＧ的水平明显相关 (γ =0 172 ,Ｐ=0 0 19) ,而和ＩｇＭ无关 (γ =0 0 84 ,Ｐ >0…     

山东省自然人群梅毒血清阳性率及影响因素分析

目的:了解山东省自然人群梅毒血清阳性率及影响因素并对梅毒网络报告数据质量进行评估。方法:采用多阶段复杂抽样法选择全省12个县(市、区)年龄为18~49岁的常住人口共8074人。收集梅毒感染的社会人口学特征及其影响因素,采用单因素和多因素回归分析梅毒感染的危险因素。估算山东省自然人群梅毒发病率并与传染病网络直报系统中梅毒数据进行比较。结果:本研究共纳入有效样本7256份,梅毒血清阳性例数为23例,梅毒血清阳性率为0.30%(95%CI 0.06%~0.53%)。其中鲁东地区梅毒血清阳性率为0.77%(95%CI 0.67%~0.86%),是其它地区的1.71~11.00倍;城镇居民梅毒血清阳性率为0.47%(95%CI 0.19%~0.74%),是农村居民的6.71倍。多因素logistic回归分析显示,居住地为城镇(a OR=6.67,95%CI 1.59~25.00)、职业为农民工(a OR=4.81,95%CI 2.78~8.31)、过去一年家庭人均月收入>1000元(a OR=10.51,95%CI 2.28~48.39)、饮酒间隔时间≤7天(a OR=2.66,95%CI 1.07~6.59)、不知道安全套的使用方法(a OR=2.19,95%CI 1.17~4.11)、过去一年去过娱乐场所(a OR=1.94,95%CI 1.31~2.87)和过去一年新性伴的个数≥2个(a OR=5.63,95%CI 1.14~27.86)是梅毒感染的危险因素。估算山东省自然人群梅毒发病率为41.32/10^(5),是报告发病率(15.46/10^(5))的2.67倍(95%CI 1.91~4.42)。结论:山东省梅毒防治应以鲁东地区和城镇居民为重点,对农民工、文化程度较低、酗酒、经常出入娱乐场所及多性伴人群也应重点关注。梅毒报告发病率低于实际水平,仍需进一步加强医疗机构的梅毒报告管理。     

银屑病与肾脏疾病风险相关性队列研究的meta分析

目的研究银屑病与肾脏疾病之间的关系。方法通过检索Medline、Pub Med、Embase、Cochrane Library、万方数据库、中国知网,收集银屑病患者肾脏疾病发生风险的队列研究文献。所有的统计学处理均采用Stata 12.0软件。结果 6篇队列研究文献符合入选标准。将各研究调整后的效应值及其95%可信区间合并后发现,纳入的6篇队列研究文献,经异质性检验采用随机效应模型进行meta分析,结果显示与非银屑病患者相比,银屑病患者患肾脏疾病风险增加(OR=1.17,95%CI 1.07~1.29),重度银屑病患慢性肾脏疾病的发病风险更高(OR=2.06,95%CI 1.93~2.2),均具有统计学意义。结论银屑病能显著增加肾脏疾病的发病风险。     

系统性红斑狼疮糖皮质激素抵抗的研究

系统性红斑狼疮(SLE)是一种典型的自身免疫性炎症性结缔组织疾病,临床上可表现为多系统、多脏器受累。文中从GC及糖皮质激素受体(GR)作用途径,SLE耐药受体前机制、受体水平机制及受体后机制的研究阐述系统性红斑狼疮糖皮质激素抵抗的原因。     

系统性红斑狼疮患者真菌感染的调查研究

回顾性分析120例系统性红斑狼疮患者的临床资料,了解系统性红斑狼疮患者真菌感染情况和危险因素.结果显示,系统性红斑狼疮患者真菌感染率为15.83%,真菌感染与糖皮质激素的用量、免疫抑制剂、广谱抗生素的使用有关.真菌感染是系统性红斑狼疮患者的常见并发症,其中白念珠菌感染占首位.应重视其诱发因素,早期诊断和治疗.     

阴道镜直视检查在子宫颈上皮内瘤样病变切除手术中的临床意义

目的:本文研究了在子宫颈上皮内瘤样病变切除手术中应用阴道镜直视检查对患者治疗的临床意义。方法:对我院2009年2月至2010年7月期间进行切除治疗的254例子宫颈上皮内瘤样病变患者的临床资料进行了回顾性分析。结果:在子宫颈上皮内瘤样病变切除手术中应用阴道镜直视能够显著降低切除样本的平均高度和直径。患者平均随访时间为(29.2±3.1)月。39例患者最终确认为治疗无效。采用阴道镜直视切除手术的患者相对于手术中不采用阴道镜的患者,其治疗失败风险并无显著差异(HR:0.49;95%CI 0.21~2.33,P=0.468),而相对于阴道镜检查后立即进行切除手术的患者也无显著差异(HR:0.92;95%CI 0.57~1.68,P=0.846)。对治疗失败风险有显著影响的因素是清晰边界的确定(HR:0.35;95%CI 0.20~0.73,P=0.003)和手术切除直径(HR:2.56;95%CI 0.98~5.89,P=0.068)。结论:应用阴道镜直视于子宫颈上皮内瘤样病变切除手术中能够显著降低切除样本的尺寸,但不会导致治疗失败风险的显著变化。     

Nested case-control study of cervical mucosal lesions, ectopy, and incident HIV infection among women in Cape Town, South Africa

OBJECTIVE: The objective of this study was to test whether cervical mucosal lesions and ectopy increase women's susceptibility to HIV infection. STUDY DESIGN: HIV-seronegative women ages 35 to 65 years (n = 5773) enrolled into a cervical cancer screening trial were followed for up to 36 months. All HIV seroconverters (n = 86) in the cohort were compared with randomly selected controls (n = 324) who did not seroconvert. Magnified photographs of the cervix taken during speculum examination at enrollment were evaluated for cervical mucosal lesions and ectopy using standard criteria. RESULTS: The presence of mucosal lesions (observed among 19% of controls) was associated with increased risk of HIV seroconversion (adjusted odds ratio [AOR] = 1.93; 95% confidence interval [CI] = 1.07-3.48). Ectopy extending over >20% of the cervix was also associated with HIV seroconversion (AOR = 2.18; 95% CI = 1.01-4.69). CONCLUSIONS: Visible lesions of cervical mucosa and cervical ectopy may be markers of increased susceptibility to HIV infection among women. Protection of the mucosa of the cervix may provide an important approach for new HIV prevention technologies.     

子宫颈细胞学检查未见异常的HR-HPV亚型感染妇女的CIN2,3风险分析

目的:探讨子宫颈细胞学检查未见异常的HPV高危亚型感染者的管理模式。方法:收集2010年1月至2012年12月在北京大学第一医院妇产科门诊同时行宫颈细胞学检查及HPV DNA分型检测的妇女的资料,分析初次检出细胞学未见异常者的HPV高危亚型16、18、31、33感染者,其检出CIN2及以上病变的风险以及与感染亚型的相关性。结果:993例细胞学检查未见异常但HPV16、18、31、33型阳性者中,共检出CIN1 76例(7.7%),CIN2 50例(50/993,5.0%),CIN3 27例(27/993,2.7%);其中HPV16(+)感染者532例(532/993,53.6%),检出CIN2 34例(34/532,6.4%),CIN3 21例(21/532,3.9%);HPV18(+)HPV16(-)感染者142例(142/993,14.3%),检出CIN2 2例(2/142,1.4%),CIN3 1例(1/142,0.7%);HPV31(+)HPV16\18(-)感染者137例(137/993,13.8%),检出CIN2 9例(9/137,6.6%),CIN3 2例(2/137,1.5%);HPV33(+)HPV16\18(-)感染者182例(182/993,18.3%),检出CIN2 5例(5/182,2.7%),CIN3 3例(3/182,1.6%)。按是否检出CIN2+进行Logistic回归分析,发现HPV16型感染与CIN2+有相关性[OR值=2.353(95%CI 1.004~5.516),P=0.049]。结论:对筛查中初次检出宫颈细胞学未见异常,但HPV高危亚型感染者应予以重视,对于HPV16、18型感染者建议立即行阴道镜检查。     

The association between physical activity and the risk of incident psoriasis

OBJECTIVE To examine the association between total physical activity, walking, and vigorous exercise and the incidence of psoriasis in women. DESIGN Cohort study. SETTING The Nurses' Health Study II, a cohort of 116?430 women aged 27 to 44 years in 1991. PARTICIPANTS The study population included 86?655 US female nurses who reported whether they had ever been diagnosed as having psoriasis and who completed detailed physical activity questionnaires in 1991, 1997, and 2001. We excluded participants with a history of psoriasis prior to 1991. MAIN OUTCOME MEASURES Risk of psoriasis by quintile of physical activity as measured by a metabolic equivalent task score. RESULTS We documented 1026 incident psoriasis cases during 1 195?703 person-years of follow-up (14 years, 1991-2005). After adjusting for age, smoking, and alcohol use, increasing physical activity was inversely associated with the risk of psoriasis. The most physically active quintile of women had a lower multivariate relative risk (RR) of psoriasis (0.72 [95% CI, 0.59-0.89; P?<?.001 for trend]) compared with the least active quintile. Vigorous physical activity (≥6 metabolic equivalents) was associated with a reduced risk of psoriasis (multivariate RR for the highest quintile, 0.66 [95% CI, 0.54-0.81; P?<?.001 for trend]); this association remained significant after adjusting for body mass index (RR, 0.73 [95% CI, 0.60-0.90; P?=?.009 for trend]). Walking was not associated with psoriasis risk. In a subset of 550 confirmed psoriasis cases, we observed a similarly reduced risk of psoriasis associated with vigorous physical activity (multivariate RR for the highest quintile, 0.64 [95% CI, 0.48-0.86; P?=?.03 for trend]). CONCLUSION In this study of US women, vigorous physical activity is independently associated with a reduced risk of incident psoriasis.     

Incidence, mortality, and disease associations of pyoderma gangrenosum in the United kingdom: a retrospective cohort study

Pyoderma gangrenosum (PG) is an important disease with significant complications. The objectives of this study were to determine incidence and mortality of PG and strength of reported associations. A retrospective cohort study was completed using computerized medical records from the General Practice Research Database, a large representative UK database. Patients with PG and three groups of age-, sex-, and practice-matched controls-general population, rheumatoid arthritis (RA), and inflammatory bowel disease (IBD) controls-were included in the study. Incidence and mortality were determined and validation undertaken to inform diagnostic accuracy. In all there were 313 people with the median age of 59 (interquartile range 41-72) years, and of them 185 (59%) were female. The adjusted incidence rate standardized to European standard population was 0.63 (95% confidence interval (CI) 0.57-0.71) per 100,000 person-years. The risk of death was three times higher than that for general controls (adjusted hazard ratio=3.03, 95% CI 1.84-4.73, P<0.001), 72% higher than that for IBD controls (adjusted hazard ratio=1.72, 95% CI 1.17-2.59, P=0.013), with a borderline increase compared with RA controls (adjusted hazard ratio=1.55, 95% CI 1.01-2.37, P=0.045). Disease associations were present in 110 (33%) participants: IBD, n=67 (20.2%); RA, n=39 (11.8%); and hematological disorders, n=13 (3.9%). To our knowledge, there are no previous population-based studies of the epidemiology of PG, an important disease with significantly increased mortality.     

High levels of ultraviolet B exposure increase the risk of non-melanoma skin cancer in psoralen and ultraviolet A-treated patients

Sunlight and psoralen and ultraviolet A (PUVA) are risk factors for the development of squamous cell carcinoma (SCC) and, to a lesser extent, basal cell carcinoma (BCC). Ultraviolet B (UVB) therapy, used for the treatment of psoriasis, might also increase the risk of these tumors. We studied the relation of skin cancer incidence to UVB use among 1380 adult subjects enrolled in a long-term safety trial of PUVA therapy. We used negative binomial regression models to quantify the association between UVB and the development of non-melanoma skin cancer (NMSC), controlling for known confounders. High UVB exposure (> or =300 treatments vs <300 treatments) was associated with a modest but significant increase in SCC (adjusted incidence rate ratio (IRR)=1.37, 95% confidence interval (CI)=1.03-1.83) and BCC (adjusted IRR=1.45, 95% CI=1.07-1.96) risk. Among patients with <100 PUVA treatments, high UVB exposure was significantly associated with the development of SCC (adjusted IRR=2.75, 95% CI=1.11-6.84) and BCC (adjusted IRR=3.00, 95% CI=1.30-6.91) on body sites typically exposed to UVB therapy but not on chronically sun-exposed sites typically covered during therapy. For adults with high UVB exposure levels, UVB confers a modest increase in NMSC risk, much less than that observed with PUVA. Therefore, UVB remains a relatively low-risk treatment for psoriasis.     

宫颈高危型人乳头瘤病毒感染与宫颈病变相关性研究

目的:研究宫颈高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)与宫颈病变患者相关性,为宫颈病变患者诊断及防治提供参考。方法:选取2014年6月至2015年12月在余姚市人民医院和浙江大学医学院附属妇产科医院共同收治的宫颈病变病人282例,其中包含55位慢性宫颈炎病人、65位宫颈上皮瘤样病变(CIN)Ⅰ期病人、91位CINⅡ期病人和71位CINⅢ期病人,荧光定量PCR方法对HR-HPV-DNA分型及和病毒载量进行检测,同时使用SPSS20.0统计软件进行数据分析。结果:282例研究对象中发现有196例病人感染HR-HPV,阳性率为69.50%,HR-HPV亚型主要有HPV16和HPV18,其所占比例为30.61%和21.43%;CINⅠ~Ⅲ期的病人HR-HPV阳性率和病毒载量比慢性宫颈炎病人的都高(P0.05);但是CINⅠ~Ⅲ期病人HR-HPV阳性率的对比,差异没有统计学意义(P0.05),同时发现病毒载量病人的病变严重情况呈正相关。结论:HR-HPV和病毒载量是影响宫颈病变的重要高危因素,本研究发现HR-HPV和病毒载量和宫颈病变相关紧密,病毒载量和宫颈病变严重情况为正相关性,宫颈病变的高发度和HR-HPV感染紧密相关。     

The impact of psoriasis on pregnancy outcomes

Psoriasis is an inflammatory disease that affects women in their reproductive years. Other similar diseases have been associated with adverse pregnancy outcomes. We sought to assess whether pregnant women with psoriasis are at higher risk of developing complications, such as preterm birth (PTB) and low birth weight (LBW). A retrospective cohort, performed at two large tertiary centers, evaluated the outcomes of 162 pregnancies in 122 women with psoriasis and 501 pregnancies in 290 women without psoriasis. Univariable and multivariable analyses, adjusting for important demographic factors, comorbidities, or a propensity score, were performed to evaluate the association of psoriasis and a poor outcome composite (POC), including PTB (<37 gestational weeks) and LBW (<2,500 g). Repeated measures analysis was used to account for the multiple pregnancies per woman. Cesarean delivery, preeclampsia/eclampsia, and spontaneous abortion were also evaluated. For women with psoriasis, there was a 1.89-fold increase in odds of POC (95% CI 1.06-3.39) in the univariable analysis. This effect remained statistically significant in the multivariable analyses. Psoriasis was not associated with cesarean delivery, preeclampsia/eclampsia, and spontaneous abortion. This study has shown higher odds of POC in patients with psoriasis. Further larger population-based studies are required to confirm these findings.     

Increased risk of diabetes mellitus and likelihood of receiving diabetes mellitus treatment in patients with psoriasis

OBJECTIVE To assess the risk of incident diabetes mellitus (DM) in patients with psoriasis and to evaluate DM treatment patterns among patients with psoriasis and incident DM. DESIGN Population-based cohort study. SETTING United Kingdom-based electronic medical records. PATIENTS We matched 108?132 patients with psoriasis aged 18 to 90 years with 430?716 unexposed patients based on practice and time of visit. For our nested study, only patients who developed incident DM during our study time were included. MAIN OUTCOME MEASURES Incident DM and adjusted risk of pharmacotherapy among those with incident DM. RESULTS The fully adjusted hazard ratios (95% CIs) for incident DM were 1.14 (95% CI, 1.10-1.18), 1.11 (95% CI, 1.07-1.15), and 1.46 (95% CI, 1.30-1.65) in the overall, mild, and severe psoriasis groups, respectively. Among those with incident DM and severe psoriasis, the adjusted risk for receiving DM pharmacotherapy was 1.55 (95% CI, 1.15-2.10). CONCLUSIONS Our results suggest that psoriasis is an independent risk factor for the development of type 2 DM in a dose-dependent manner, and that patients with severe psoriasis who develop DM are more likely to receive systemic diabetic therapies in comparison with patients with DM but without psoriasis.