Objective To summarize results of the correlation of tumor necrosis factor-α (TNF-α) promoter –308A/G polymorphism with systemic lupus erythematosus (SLE) susceptibility in Chinese populations. Methods We collected all the publications about the correlation between TNF-α promoter –308A/G polymorphism and SLE in Chinese populations by searching PubMed, EBSCO, CBM, CNKI and Wanfang Data before the date of March 20, 2010. Meta-analysis was performed for checking the difference between two groups about genotypes such as AA versus GG, GA versus GG, AA versus GG+GA, GA+AA versus GG, and A allele versus G allele. Results A total of 8 studies involving 731 SLE patients and 901 healthy people were included. The meta-analysis of total populations showed that, there was no significant correlation between A allele and increased SLE risk (OR=1.42, 95%CI 0.97 to 2.09, P=0.07); the meta-analyses of populations in different regions showed there was no significant correlation of A allele and increased SLE risk in Chinese Taiwan populations (OR=1.04, 95%CI 0.77 to 1.40, P=0.82). Moreover, there was no significant difference between SLE group and control group in the genotypes of AA versus GG, GA versus GG, AA versus GG+GA, and GA+AA versus GG.Conclusion This meta-analysis dosen’t demonstrate the correlation between TNF-α promoter–308A/G polymorphism and SLE in Chinese populations.
ObjectiveSystemic lupus erythematosus (SLE) patients from a SLE family with homogeneity can provide experimental basis for individualized diagnosis and treatment by studying the characteristics of laboratory tests and symptoms.
MethodsLaboratory tests were analyzed for three SLE patients in the family, and set up the screen model by three laboratory tests (anitnuclear antibody positive, rheumatoid factor positive and IgE positive, ANA+RF+IgE+). All SLE cases were screened from latest four years as SLE subtype patients (named "similar family SLE patients"), then the family laboratory tests and clinical characteristics were analyzed.
ResultsA total of 55 patients (6.27%) were screened as similar family SLE patients from individual SLE patients according to model from 877 cases. The laboratory tests of similar family SLE patients including creatinine, WBC, CRP were significant lower than other SLE patients (P < 0.05), but significant higher for the IgG, positive rate of anti-SSA and anti-SSB (P < 0.05), and the alopecia and skin rashes were more common in similar family SLE patients than other SLE patients.
ConclusionsThe ANA+RF+IgE+ SLE patients are of lower inflammatory state and kidney involvement; Clinical symptom is priority to alopecia and skin rashes.
ObjectiveTo evaluate the value of spiral CT in diagnosing ischemic bowel changes in systemic lupus erythematosus (SLE) patients presenting with acute abdominal pain. MethodsThe clinical data and spiral CT imaging files of 23 SLE patients presenting with acute abdominal pain were retrospectively reviewed. Sixteen had contrastenhanced spiral CT scanning of the abdomen, the rest had plain CT study. Observation emphasis was placed on the changes of bowel wall (wall thickness, enhancement pattern, lumen size) and mesentery (mesenteric edema, engorgement of mesenteric vessels and their abnormal arrangement pattern). Other abnormal findings (e.g. fluid accumulation, changes of abdominal solid organs, lymphadenopathy) were also observed. ResultsNineteen patients had intestinal wall thickening (19/23, 82.6%), with the “target sign” in 12 patients (12/16, 75.0%); Bowel lumen dilatation was present in 16 patients (16/23, 69.6%). Mesenteric swelling with increased density of adipose tissue was noticed in 21 patients (21/23, 91.3%); 18 patients had engorgement of mesenteric vessels (18/23, 78.3%), with comb like arrangement in 4 patients (4/16, 25.0%). Other abnormal findings included ascites, hydrothorax, hydropericardium, hepatosplenomegaly and so on. ConclusionThe most common CT findings in SLE patients presenting with acute abdominal pain are the signs associated with ischemic bowel disease. Contrastenhanced spiral CT is a preferable imaging method for both the diagnosis and differential diagnosis of ischemic bowel disease associated with SLE.
ObjectiveTo evaluate diagnostic performance of crithidia luciliae immunofluorescence test (CLIFT), enzyme linked immunosorbent assay (ELISA), linear immunoassay (LIA) and chemiluminescence immunoassay (CLIA) for detection of anti-dsDNA antibodies for systemic lupus erythematosus (SLE).
MethodsA total of 178 sera[SLE (n=86), other systemic rheumatic diseases (n=62), and healthy individual (n=30)], from whom received treatment from July 2012 to June 2013, were tested by 4 different assay kits.
ResultsThe diagnostic performances of four methods for detecting anti-dsDNA antibodies for SLE were ELISA, CLIA, CLIFT and LIA, from higher to lower; while ELISA had the highest sensitivity (67.4%), and CLIA had the highest specificity (95.6%). The three test methods (ELISA, LIA, CLIA) had almost perfect concordance with the comparison method (CLIFT, Kappa >0.8). With cut-off values set at 95% of specificity, there was no statistical difference of sensitivity between ELISA and CLIA (58.1%, 60.5%; P>0.05).
ConclusionFour assays can be used for the clinical detection of anti-dsDNA antibodies, and the results have an almost perfect concordance. Different assays show various performances depending on the methods and cut-off values used.
ObjectiveTo systematically review the diagnostic value of anti-C1q antibodies for lupus nephritis (LN) in Chinese population.
MethodsWe electronically searched databases including PubMed, EMbase, CNKI, The Cochrane Library, VIP and WanFang Data for diagnostic accuracy studies of anti-C1q antibodies for LN in Chinese population from inception to 1st March, 2015. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies by QUADAS tool. Then, meta-analysis was performed by Meta-DiSc 1.4 software and Stata 11.0 software.
ResultsA total of 11 studies involving 1 084 systemic lupus erythematosus (SLE) patients were included. Among them, 474 patients were LN. The results of meta-analysis showed that:the pooled sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio of anti-C1q in the diagnosis of LN were 0.67 (95%CI 0.63 to 0.71), 0.69 (95%CI 0.65 to 0.74), 5.09 (95%CI 3.29 to 7.85), 2.18 (95%CI 1.75 to 2.72), and 0.48 (95%CI 0.39 to 0.60), respectively. The area under the curve (AUC) of SROC was 0.749 6 and the Q index value was 0.693 1. The average missed diagnosis rate was 33.0% and the misdiagnosis rate was 31.0%.
ConclusionCurrent evidence indicates that anti-C1q antibodies may have some value in the diagnosis of LN. Because of the high missed diagnosis rate and the misdiagnosis rate, it could not be used to diagnose LN alone, and it only could be used as an adjuvant diagnostic indicator for LN. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To describe the disease characteristics of osteonecrosis of the femoral head (ONFH) in patients with systemic lupus erythematosus (SLE) who experiencing prolonged glucocorticoid (GC) exposure. Methods Between January 2016 and June 2019, 449 SLE patients meeting the criteria were recruited from multiple centers. Hip MRI examinations were performed during screening and regular follow-up to determine the occurrence of ONFH. The cohort was divided into ONFH and non-ONFH groups, and the differences in demographic baseline characteristics, general clinical characteristics, GC medication information, combined medication, and hip clinical features were compared and comprehensively described. ResultsThe age at SLE diagnosis was 29.8 (23.2, 40.9) years, with 93.1% (418 cases) being female. The duration of GC exposure was 5.3 (2.0, 10.5) years, and the cumulative incidence of SLE-ONFH was 9.1%. Significant differences (P<0.05) between ONFH and non-ONFH groups were observed in the following clinical characteristics: ① Demographic baseline characteristics: ONFH group had a higher proportion of patients with body mass index (BMI)<20 kg/m2 compared to non-ONFH group. ② General clinical characteristics: ONFH group showed a higher proportion of patients with cutaneous and renal manifestations, positive antiphospholipid antibodies (aPLs) and anticardiolipin antibodies, severe SLE patients [baseline SLE Disease Activity Index 2000 (SLEDAI-2K) score ≥15], and secondary hypertension. Fasting blood glucose in ONFH group was also higher. ③ GC medication information: ONFH group had higher initial intravenous GC exposure rates, duration, cumulative doses, higher cumulative GC doses in the first month and the first 3 months, higher average daily doses in the first 3 months, and higher proportions of average daily doses ≥15.0 mg/d and ≥30.0 mg/d, as well as higher full-course average daily doses and proportion of full-course daily doses ≥30.0 mg/d compared to non-ONFH group. ④ Combined medications: ONFH group had a significantly higher rate of antiplatelet drug use than non-ONFH group. ⑤ Hip clinical features: ONFH group had a higher proportion of hip discomfort or pain and a higher incidence of hip joint effusion before MRI screening than non-ONFH group. Conclusion The incidence of ONFH after GC exposure in China’s SLE population remains high (9.1%), with short-term (first 3 months), medium-to-high dose (average daily dose ≥15 mg/d) GC being closely associated with ONFH. Severe SLE, low BMI, certain clinical phenotypes, positive aPLs, and secondary hypertension may also be related to ONFH.
Objective To discuss the rules of using traditional Chinese medicine (TCM) to treat systemic lupus erythematosus (SLE) and Sj?gren syndrome (SS). Methods The TCM prescriptions for patients with SLE or SS treated at the Department of Rheumatology of Longhua Hospital, Shanghai University of Traditional Chinese Medicine between January 2013 and July 2021 were collected. The prescriptions collected were broken down and analyzed for frequencies of the efficacies, properties, flavors and meridian tropisms of drugs in the prescriptions. The correlation and clustering analysis was performed in VOSviewer software. Results The medication information of 3689 cases of inpatients was included, from which 69167 pieces of data of using TCM prescriptions were extracted. The top 20 high-frequency drugs for treating SLE patients were mainly drugs for promoting blood circulation and removing blood stasis, qi-tonifying drugs, and drugs for heat clearing and detoxicating, which were mostly sweet, bitter or acrid in flavor, cold, warm or neutral in properties, and of the spleen, liver or stomach meridian. The drugs could be seperated into 3 clusters, the blue cluster mainly included qi-tonifying drugs, blood-tonifying drugs, and drugs for promoting blood circulation and removing blood stasis; the green cluster mainly included drugs for heat clearing and drugs for promoting blood circulation and removing blood stasis; and the red cluster mainly consisted of drugs for promoting blood circulation and removing blood stasis, drugs for inducing diuresis and alleviating edema, drugs for dispelling wind-heat, and digestant drugs. The top 20 high-frequency drugs for treating SS patients were mainly drugs for promoting blood circulation and removing blood stasis, qi-tonifying drugs, and drugs for inducing diuresis and alleviating edema, which were mostly sweet, bitter or acrid in flavor, slightly cold, cold or warm in properties, and of the spleen, stomach or liver meridian. The drugs could be seperated into 2 clusters, the green cluster mainly consisted of yin-tonifying drugs, drugs for promoting blood circulation and removing blood stasis, and drugs for heat clearing; the red cluster mainly included qi-tonifying drugs, drugs for promoting blood circulation and removing blood stasis, and drugs for inducing diuresis and alleviating edema. Conclusions The medication for SLE is in line with the treatment principle of “supplementing qi and nourishing yin, detoxicating and removing stasis”; the medication for SS, on the other hand, agrees with the basic rule of “nourishing yin and clearing away heat, promoting body fluid to moisten dryness”. Both are based on the approach of strengthening the body resistance, which is in line with the diagnostic and treatment ideas of rheumatology department and may offer the ideas of TCM syndrome differentiation for clinical use of drugs and thereby guiding the current clinical practice.
Objective
To explore the relevances of serum prolactin level to clinical symptoms and disease activities of systemic lupus erythematosis (SLE).
Methods
From December 2008 to December 2014, 63 female patients who met the American Rheumatism Society diagnostic criteria of SLE in the First People’s Hospital of Chengdu were collected as the SLE group, and other 20 healthy females were collected as the control group. The serum prolactin level was determined by immunofluorescence, and the disease activity of SLE was assessed by SLE Disease Activity Index (SLEDAI). The relevances of serum prolactin level to clinical symptoms and disease activity of SLE patients were analyzed.
Results
The mean serum prolactin level was (22.35±14.86) ng/mL in the SLE group and (15.30±8.54) ng/mL in the control group, respectively; the difference was statistically significant (P<0.05). In the 63 SLE patients, 15 (23.8%) had higher serum prolactin level compared with the normal ones. According to the SLEDAI score, the SLE patients were divided into stable group (25 patients), mild activity group (21 patients), moderate activity group (10 patients), and severe activity group (7 patients); and their serum prolactin levels were (20.43±11.23), (22.50±13.54), (27.97±21.20), and (33.91±18.18) ng/mL, respectively; the differences were not statistically significant (P>0.05). There were statistically significant differences (P<0.05) between the SLE patients with hyperprolactinemia and the ones with normal serum prolactin level in a number of clinical symptoms such as serositis, kidney damage,hematological system damage, and hypocomplementemia, but the serum prolactin level was not significantly correlated with the SLEDAI (rs=0.217, P=0.088).
Conclusions
Less hyperprolactinemia is found in SLE patients. Serum prolactin level is correlated with multiple clinical symptoms and laboratory indexes but not related to disease activity in SLE patients.
Objective This study employs Mendelian randomization analysis to explore the causal relationship between dietary habits and systemic lupus erythematosus (SLE). MethodsWe obtained data from the MRC-IEU database on five dietary habits as instrumental variables for exposure "never eating dairy products" "never eating eggs or foods containing eggs" "never eating sugar or foods/drinks containing sugar" "never eating wheat products" and "I eat all of the above". Summary data related to SLE were retrieved from the MRC-IEU database for the discovery cohort (designated as MSLE) and from a Finnish database for the validation cohort (recorded as FSLE). Two-sample Mendelian randomization analyses were conducted using inverse variance weighting (IVW), MR-Egger, weighted median, Simple Mode, and Weighted Mode methods to investigate the causal relationship between dietary habits and SLE. The MR-Egger intercept test was performed to assess the presence of horizontal pleiotropy, while the leave-one-out method was employed to verify the stability of the results, with Cochran’s Q test and funnel plots used to evaluate heterogeneity. ResultsMendelian randomization analysis indicated that never eating wheat products increases the risk of developing SLE (IVW: P<0.05). In contrast, there was no significant causal relationship between the consumption of dairy products, eggs or foods containing eggs, or the consumption of all of the above with SLE (IVW: P>0.05). Additionally, there was no significant causal relationship between never sugar or foods/drinks containing sugar and MSLE (IVW: P=0.877), although a potential causal association with FSLE was suggested (IVW: P=0.016). The MR-Egger intercept test indicated no evidence of horizontal pleiotropy (P>0.05). ConclusionNever eating wheat products may be an independent risk factor for SLE. However, the causal relationship between never sugar or foods/drinks containing sugar and SLE remains indeterminate.
Objective
To investigate the clinical characteristics of spontaneous pneumothorax secondary to systemic lupus erythematosus (SLE).
Methods
A case of spontaneous pneumothorax secondary to SLE was reported and related literatures were reviewed.
Results
A female patient, 26 years old, complaining of repeated fever for 3 months, chest tightness and shortness of breath more than 10 days, was hospitalized in December 2016. After admission, the patient was diagnosed as acute lupus pneumonia and received glucocorticoid, cyclophosphamide and plasma exchange therapy. Sudden right chest pain happened during hospitalization. Bedside chest CT showed right pneumothorax. After closed thoracic drainage, the syndrome of the patient was improved. A total of 14 patients were reviewd but 2 patients were excluded because of incomplete data. The left patients included 9 females and 3 males. The mean age was (28.0±11.9) years. Clinical manifestations of spontaneous pneumothorax secondary to SLE were sudden chest tightness and shortness of breath accompanied by subpleural lung cavity and vesicular changes. The majority of patients could be cured with drainage.
Conclusions
Pneumothorax secondary to SLE is rare which is associated with the rupture of cavity and cyst in pulmonary secondary to SLE. Majority of patients with pneumothorax could be cured after closed thoracic drainage.
