系統性紅斑狼瘡（systemic lupus erythematosus，SLE）是一種女性多發、累及多器官的慢性難治性自身免疫性疾病。白細胞介素（interleukin，IL）-21 是一種具有多種生物學功能的細胞因子，主要由活化 T 細胞合成與分泌，其受體分布廣泛，與 B 細胞表面的 IL-21 受體結合可調控 B 細胞，包含正向促進 B 細胞向漿細胞分化，調節免疫球蛋白產生；反向條件性誘導 B 細胞凋亡及 B10 細胞產生兩方面作用。正向作用在于促使 SLE 患者產生自身抗體，而反向作用是促使產生自身抗體的 B 細胞數量減少，而且使 B10 細胞產生更多的具有免疫抑制作用的 IL-10。正反向平衡精準調控有助于對 SLE 病情進行條件性干預，對于疾病的治療具有重要潛在價值。該文探討了 IL-21 調控 B 細胞的分化及其與 SLE 之間的關系，對探索 IL-21 對 B 細胞的信號通路在 SLE 發病機制和靶向治療提供新的思路。
Objective To explore the construction and application of a new follow-up visit model in the context of Internet hospital consultation, aiming to create a novel follow-up visit model that integrates precise identification of follow-up patients, messages of follow-up reminders, online free follow-up visits, and promotional activities. Methods Satisfaction surveys were conducted among outpatient patients and doctors at Jintang County First People’s Hospital from July 2023 to June 2024. Patients and doctors were divided into two groups based on whether the online free follow-up visit program had been implemented: the pre-implementation group (July to December 2023) and the post-implementation group (January to June 2024). The satisfaction levels of patients and doctors before and after the implementation were compared and analyzed. Results A total of 17 831 patient visits and 801 doctor visits were included. Since its launch, WeChat messages had been pushed to all outpatient patients, and both WeChat and SMS messages had been pushed to patients in surgical departments. The average waiting time for outpatient visits in January-June 2024 was shortened by 2 minutes compared with the same period last year (January-June 2023). The hospital’s Case Mix Index increased by 3.7%, and the surgical volume increased by 7.5%. After the launch of the Internet hospital, both patient and doctor satisfaction improved. Conclusion The new follow-up visit model of the Internet hospital represents an important initiative in the digital transformation of hospitals and holds value and significance for promotion in more county-level medical institutions.
ObjectiveTo analyze the correlation between anti-cell membrane DNA (mDNA) antibodies and other autoantibodies and estimate its diagnosing significance for systemic lupus erythematosus (SLE).
MethodsFrom January to August 2015, the sera samples from 254 patients with various autoimmune diseases, including 106 SLE, 80 rheumatoid arthritis (RA), 32 mixed connective tissue disease (MCTD), 29 Sjogren's syndrome (SS), 7 polymyositis/dermatomyositis (PM/DM) and 20 healthy controls, were collected. The anti-mDNA antibody, anti-dsDNA antibody, antinuclear antibody (ANA) and anti-keratin antibody (AKA) were detected by indirect immunofluorescent assay; anti-cyclic citrylinated peptide antibody (CCP) antibody was detected by enzyme-linked immuno sorbent assay; rheumatoid factor (RF) was detected by rat scatter turbidimetry assay; and anti-Sm antibody was detected by Western blotting method.
ResultsAnti-mDNA antibody was found in 77 of 106 SLE (72.6%), 4 of 80 RA (5.0%), 6 of 32 MCTD (18.7%), 4 of 29 SS (14.7%), 0 of 7 PM/DM (0.0%) and 0 of 20 healthy controls (0.0%), respectively. It's notable higher in SLE than that in the others (P < 0.001). The sensitivity, specificity and diagnosis efficiency of anti-mDNA antibody for SLE were 72.6%, 91.7% and 84.3%, respectively. Anti-mDNA antibody was significantly correlated with ANA, anti-dsDNA antibody and anti-Sm antibody (P < 0.001), while it had no significant correlation with anti-CCP antibody, AKA and RF (P > 0.05).
ConclusionAnti-mDNA antibody is closely related with other SLE associated antibodies and with high sensitivity and specificity for SLE diagnosis.
ObjectiveTo verify the consistency between artificial interpretation and automatic interpretation by HELIOS automatic immunofluorescence system by comparing their results on the same antinuclear antibodies (ANA) fluorescent slides, and analyze the application of automatic interpretation clinically.
MethodA total of 281 ANA fluorescent slides of 281 impatients or outpatients in February 2015 were analyzed by HELIOS automatic immunofluorescence system and artificial interpretation respectively. As HELIOS could only determine the titer not the fluorescence type, only the negative or positive results qualitatively and the titer of ANA positive slides were analyzed.
ResultsThere was no statistically significant difference between HELIOS automatic immunofluorescence system and artificial interpretation in negative or positive rate qualitatively (P>0.05) . The total coincidence rate was 98.9%, the positive coincidence rate was 99.5%, and the negative coincidence rate was 97.4%, and the kappa coefficient was 0.973. The difference of titer between the two groups had no statistical significance (P>0.05) .
ConclusionsThe results of HELIOS automatic Immunofluorescence system and artificial interpretation are in good consistency. HELIOS automatic immunofluorescence system is suitable for clinical use as its high degree of automation, simple operation and result reliability.
ObjectiveTo study the diagnosis value of anti-SSa (including anti-Ro52 and anti-Ro60).
MethodsAntibodies of ENA (including Sm, Ro52, Ro60, SSb, RNP, Scl-70, Jo-1 and Rib-P) from 23145 patients with positive antinuclear antibody (ANA) were retrospected from January 2009 to December 2013. The relationship between anti-Ro52, anti-Ro60 and other test results and the diagnosis or symptomatic information of patients was also analyzed.
ResultsThe anti-Ro60 positive rate was 35.19% (8 145/23 145), and the anti-Ro52 was 13.16% (3 046/23 145) in 23145 ANA positive cases (P<0.05). The positive percentage of anti-Ro60 was higher in anti-SSb, anti-RNP, anti-Sm and anti-Rib-P positive cases than anti-Ro52 (P<0.05); the results of anti-Ro52 negative and anti-Ro60 positive (Ro52-Ro60+) had a higher percentage in autoimmune diseases, non-autoimmune disease and symptoms groups than anti-Ro52 positive and anti-Ro60 negative (Ro52+Ro60-) results (P<0.05).
ConclusionThe anti-Ro60 has higher positive rate than anti-Ro52, and the sensitivity and prediction value of autoimmune diseases of anti-Ro60 are better than anti-Ro52. But both anti-Ro60 and anti-Ro52 have poor specificity for disease diagnosis.
