ABSTRACT
Objective:To investigate the association between ambulatory arterial stiffness index (AASI) and renal poor prognosis in patients with chronic kidney disease (CKD).Methods:A prospective study was conducted to enroll 117 non-dialysis patients with CKD who volunteered for receiving ambulatory blood pressure monitoring test from December 2017 to December 2018 in the Department of Nephropathy of the First Medical Center of Chinese PLA General Hospital. According to the AASI tertiles, patients were divided into low AASI group (≤0.414, n=38), medium AASI group (0.414-0.517, n=40), and high AASI group (≥0.517, n=39). The differences of clinical baseline information among the three groups were compared. The follow-up time was until August 2020. Kaplan-Meier curve and Cox proportional hazard regression model were used to explore the effect of AASI on renal poor prognosis. Results:The median age of 117 patients was 61(49, 65) years old. There were 80 males (68.4%) and patients with hypertension accounted for 77.8%(91 cases). After a median follow-up of 27 months, 34 cases had composite endpoint events [renal replacement therapy (dialysis or kidney transplantation), 40% estimated glomerular filtration rate (eGFR) decline, and death], of which 10 patients were on dialysis, 19 patients had 40% eGFR decline, and 5 patients died. There were significant differences in age, hemoglobin, body mass index, eGFR, 24 h systolic blood pressure (SBP), daytime SBP, nighttime SBP, morning SBP, 24 h mean arterial pressure and 24 h pulse pressure among the three groups (all P<0.05). Kaplan-Meier survival analysis indicated that higher AASI was associated with lower cumulative survival rate in patients (Log-rank test χ2=13.111, P=0.001). Univariate Cox regression analysis showed that high AASI was an influencing factor for renal endpoint events ( P<0.05), and after adjusting for age, gender, mean arterial pressure, eGFR, 24 h urine protein, diabetes and body mass index, high AASI was an independent influencing factor for renal poor prognosis in classification and continuous variable analysis models ( HR=2.88, 95% CI 1.00-8.26, P=0.050; HR=1.50, 95% CI 1.02-2.21, P=0.039). Conclusion:High AASI is an independent influencing factor for renal poor prognosis in CKD patients.
ABSTRACT
Rheumatic diseases are a kind of chronic inflammatory diseases mainly involving joints and surrounding tissues. Most patients with rheumatic diseases need long-term treatment, which is difficult to be avoided during pregnancy. Treatment efficacy, as well as maternal and fetal safety should be taken into account in the medical decision. Based on the domestic and foreign guidelines, consensus, diagnosis and treatment experience, Chinese Rheumatology Association developed the standardization of medication use in patients with rheumatic diseases preparing and during pregnancy, aiming on the application and precautions of commonly used medicines for rheumatic diseases in preparing pregnancy, pregnancy and lactation.
ABSTRACT
To investigate the social support level and its influencial factors in patients with systemic lupus erythematosus (SLE), and to develop the management strategies for chronic disease. Methods: Patients with SLE were investigated by Social Support Rating Scale (SSRS), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), 36-Item Short-Form Health Survey (SF-36) and Visual Analogue Scale (VAS) of fatigue. The demographic and clinical data of SLE patients were recorded. SLE disease activity and damage severity were assessed by SLE Disease Activity Index (SLEDAI) and SLE Damage Index (SDI), respectively. Influencial factors for social support were analyzed. Results: A total of 246 patients were included. Social support scores for these patients were 40.76±7.93 and the scores showed no significant difference with the national norm (P>0.05). Patients who were younger than 18, single, unemployed or damaged by disease showed lower level of social support (P<0.05). Compared with the high social support group, patients in the low social support group experienced more severe depression or anxiety, and scored lower on mental component summary scale (vitality, social functioning, emotional role and mental health perception) and physical role of SF-36 (P<0.05). Conclusion: Social support levels for patients with SLE are closely related to the quality of life, and influenced by age, marital status, professional condition, and disease damage. Health education for patients and their families should be strengthened in chronic disease management to enhance social support and finally, improve their quality of life.
Subject(s)
Humans , Chronic Disease , Health Status , Lupus Erythematosus, Systemic , Quality of Life , Severity of Illness Index , Social Support , Surveys and QuestionnairesABSTRACT
Objective To investigate the prevalence of sleep disorders and the relevant determinants in a cohort of systemic lupus erythematosus (SLE) patients.Methods One hundred patients with SLE were included in the study.Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI).Depression,anxiety,quality of life,and fatigue were evaluated by patient health questionnaire (PHQ)-9,generalized anxiety disorder (GAD)-7,short form 36 health survey (SF-36),and visual analogue scale (VAS) respectively.The demographic and clinical data were also recorded.SLE disease activity and damage severity were assessed by systemic lupus erythematosus disease activity index (SLEDAI) and systemic lupus erythematosus damage index (SDI) respectively.Mann-Whitnry U test,t test,Logistic regression were used for statistically analysis.Results The prevalence of sleep disorders in SLE patients was 42％.Compared with patients without sleep disorders,the ratio of males and married patients,age,the score of SDI,PHQ-9,GAD-7,and fatigue were higher in SLE patients with sleep disorders,while the score of SF-36 was lower (r＜0.05).Age,SLEDAI,SDI,PHQ-9,GAD-7,and fatigue correlated positively with sleep disorders (The values of r were 0.215,0.230,0.311,0.529,0.455,0.541,P＜0.05).C3 and the score of SF-36 correlated negatively with sleep disorders (The values of r were-0.204,-0.342,-0.490,-0.464,-0.497,-0.590,-0.428,-0.478,-0.398,-0.412,-0.659respectively,P＜0.05).In multi-ple logistic regression analyses,gender (OR=22.22),anxiety (OR =2.895),body pain (OR =0.964),and energy (OR =0.947) were the independent determinants of sleep disorders (R2=0.494,P＜0.01).Conclusion Poor sleep quality is common in SLE patients.Gender,age,disease activity and severity,anxiety,depressed mood,and quality of life contribute significantly to sleep disorders in SLE.
ABSTRACT
Systemic sclerosis (SSc) is an autoimmune disease characterized by thickening of the skin and organ fibrosis.Ankylosing spondylitis (AS) is a type of arthritis with long-term inflammation of the axial joints.Previous studies presented 5 cases of concomitant AS and SSc.However,there was only 1 patient of those 5 cases complaining of muscle weakness while all patients had approximately normal creatine kinase (CK).Here we reported a young male who met the criteria for SSc and AS while showing significantly elevated CK.Human leukocyte antigen (HLA) typing results indicated the genetic susceptibility to these two diseases.The patient was prescribed prednisone (30 mg/d)and cydophosphamide.After 2 months,the patient's skin became soft with normal CK.
ABSTRACT
Objective To investigate the white matter injury in patients with systemic lupus erythematosus (SLE) combined with cognitive dysfunction by diffusion tensor imaging (DTI).Methods The Montreal cognitive assessment,conventional magnetic resonance imaging (MRI) and DTI were performed in 11 SLE patients with cognitive dysfunction (CDF),11 SLE patients without cognitive dysfunction (nonCDF) and 10 health controls.Local gray differences among three groups were compared by SPM5 software and voxel-based analysis.Results In conventional MRI,abnormal lesions were detected in 3 CDF patients.In DTI,compared to non-CDF group,CDF patients showed significantly increased apparent diffusion coefficient (ADC) values in right precuneus and brodmann area 6,21 (P ＜0.01).No difference of fractional anisotropy (FA) was found between these two groups.Compared to health controls,CDF patients showed significantly decreased FA values in right parahippocampa gyrus,cerebellar tonsil and pons (P ＜ 0.01),and increased ADC values in right superior frontal gyrus,cuneus,middle temporal gyrus,insula,brodmann area (13,20,21,27,30,47),and left middle frontal gyrus,brodmann area 10,cingulate gyrus and corpus callosum (P ＜0.01).Compared to health controls,non-CDF patients showed significantly increased ADC values in right parahippocampa gyrus,superior frontal gyrus,brodmann area (10,25),left middle temporal gyrus,middle occipital gyrus,brodmann area (3,13,19,25),bilateral insula and corpus callosum (P ＜ 0.01),and no difference of FA.Conclusions DTI is more sensitive to detect white matter impairment of cognitive dysfunction in SLE patients than conventional MRI.
ABSTRACT
Objective To investigate the white matter injury in patients with systemic lupus erythematosus (SLE) combined with cognitive dysfunction by diffusion tensor imaging (DTI).Methods The Montreal cognitive assessment,conventional magnetic resonance imaging (MRI) and DTI were performed in 11 SLE patients with cognitive dysfunction (CDF),11 SLE patients without cognitive dysfunction (nonCDF) and 10 health controls.Local gray differences among three groups were compared by SPM5 software and voxel-based analysis.Results In conventional MRI,abnormal lesions were detected in 3 CDF patients.In DTI,compared to non-CDF group,CDF patients showed significantly increased apparent diffusion coefficient (ADC) values in right precuneus and brodmann area 6,21 (P ＜0.01).No difference of fractional anisotropy (FA) was found between these two groups.Compared to health controls,CDF patients showed significantly decreased FA values in right parahippocampa gyrus,cerebellar tonsil and pons (P ＜ 0.01),and increased ADC values in right superior frontal gyrus,cuneus,middle temporal gyrus,insula,brodmann area (13,20,21,27,30,47),and left middle frontal gyrus,brodmann area 10,cingulate gyrus and corpus callosum (P ＜0.01).Compared to health controls,non-CDF patients showed significantly increased ADC values in right parahippocampa gyrus,superior frontal gyrus,brodmann area (10,25),left middle temporal gyrus,middle occipital gyrus,brodmann area (3,13,19,25),bilateral insula and corpus callosum (P ＜ 0.01),and no difference of FA.Conclusions DTI is more sensitive to detect white matter impairment of cognitive dysfunction in SLE patients than conventional MRI.
ABSTRACT
Objective:To analyze the features of the connective tissue associated interstitial lung disease (CTD-ILD) by high resolution computed tomography (HRCT).Methods:A total of 127 patients with CTD-ILD,who were diagnosed by clinic laboratory examination and pathology in Xiangya Hospital of Central South University form September 2013 to September 2015,were enrolled for this study.Their lung features of HRCT imaging were retrospectively analyzed.Results:The classifications for 127 patients were as follows:36 cases of rheumatoid arthritis (28.3%),34 cases of dermatomyositis and polymyositis (26.8%),31 cases of systemic sclerosis (24.4%),18 cases of Sj(o)gren syndrome (14.2%),7 cases of mixed connective tissue disease (5.5%),and 1 cases of systemic lupus erythematosus (0.8%).According to the features of HRCT imaging,the patients were divided as follows:77 cases (60.6%) ofnonspecific interstitial pneumonia (NSIP),46 cases (36.2%) of usual interstitial pneumonia (UIP),2 cases (1.6%) of lymphocytic interstitial pneumonia (LIP),1 case (0.8%) of cryptogenic interstitial pneumonia (COP),and 1 case (0.8%) of acute interstitial pneumonia (AIP).The HRCT findings for 36 cases of rheumatoid arthritis associated interstitial lung disease were UIP (24 cases,66.7%) and NSIP (12 cases,33.3%);the HRCT findings for 34 cases of dermatomyositis and polymyositis associated interstitial lung disease were NSIP (32 cases,94.1%),UIP (1 case,2.9%) and COP (1 case,2.9%);the HRCT findings for 31 cases of systemic sclerosis associated interstitial lung disease were NSIP (21 cases,67.8%),UIP.(9 cases,29%),LIP(1 case,3.2%);the HRCT findings for 18 cases of Sj(o)gren syndrome associated interstitial lung disease were NSIP (9 cases,50.0%),UIP (8 cases,44.4%),LIP (1 case,5.6%);the HRCT findings for 7 cases of mixed connective tissue disease associated interstitial lung disease were UIP (4 cases,57.1%),NSIP (3 cases,42.9%).SLE-ILD was rare,with only 1 case of AIP.Conclusion:Different types of CTD-ILD patients display relatively unique manifestation of HRCT.
ABSTRACT
Objective:To analyze the trend relevant factors leading to death and their patterns over a 10-year period in inpatients with connective tissue diseases (CTDs).Methods:All clinical data about death in inpatients with CTDs were retrospectively reviewed between 2005 and 2014 at the Department of Rheumatology and Immunology in Xiangya Hospital of Central South University.Results:In the 10-year time period,the overall hospital mortality was 15.689‰.The disease itself accounted for 44.71% of the total causes of death,infection accounted for 42.94%,and comorbidities accounted for 12.35%.The constituent ratio of deaths and the average hospital mortality caused by the disease itself declined gradually year by year,and the constituent ratio of deaths caused by infection and comorbidities increased gradually year by year (P<0.05).In 2013-2014,infection was the leading cause of death,which accounted for 51.06%.The survival time for CTDs inpatients with interstitial lung disease (ILD) was shorter than that of CTDs inpatients without ILD,and even the risk of death was 1.722 times of the latter.The proportion of deaths caused by the disease itself was the highest in systemic sclerosis and systemic lupus erythematosus,that by infection was the highest in idiopathic inflammatory myopathy (IIM),and that by comorbidities was the highest in rheumatoid arthritis.Conclusion:The proportion of deaths and the hospital mortality in CTDs inpatients caused by the disease itself show a declining trend,while the proportion of deaths caused by infection and comorbidities increase.CTDs patients with ILD have shorter survival time and an increase in risk of death.
ABSTRACT
Objective To understand the diagnostic values of procalcitonin (PCT),C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),white blood cell (WBC) and neutmphilic granulocyte ratio (NE％) in distinguishing concurrent bacterial infection from idiopathic inflammatory myopathy (ⅡM).Methods Clinical data and laboratory examinations of 118 ⅡM patients were collected.The ⅡM patients were assigned to the bacterial infection group (n=66) or the non-infection group (n=52).The levels of PCT,CRP,ESR,WBC and NE％ were compared by the Mann-Whitney U tests between the two groups and receiver operating characteristic curves were generated in order to evaluate the diagnostic value.Results The levels of PCT (0.06 ng/ml,0.03 ng/ml,U=2.637,P＜0.01);CRP (15.80 mg/L,4.40 mg/L,U=5.944,P＜0.01);ESR (43.50 mm/1 h,27.00 mm/1 h,U=2.266,P＜0.05);WBC (9.85×109/L,7.70×109/L,U=2.675,P＜0.01) and NE％ (80.70％,75.75％,U=2.344,P＜0.01) were significantly higher in the ⅡM patient group with concurrent infection than in the noninfection ⅡM patient group.CRP showed the highest diagnostic value with sensitivity,specificity,positive predictive value and negative predictive value of 72.7％,82.7％,84.2％ and 70.5％,respectively.Conclusion The inflammatory biomarkers PCT,CRP,ESR,WBC and NE％ offer diagnostic accuracy in detecting bacterial infection in ⅡM patients.Particularly,CRP is the most sensitive and specific biomarker indetecting bacterial infection in ⅡM patients.
ABSTRACT
OBJECTIVE@#To improve the understanding of lupus cystitis.@*METHODS@#Clinical manifestations, laboratory Results , and image information of 2 cases of lupus cystitis were analysed retrospectively, and another 6 cases in the literature were reviewed.@*RESULTS@#Two patients were female. The urinary symptoms followed the gastrointestinal symptoms. Ureterectasia and hydronephrosis were detected in both patients, and intestinal pseudo-obstruction was detected in one patient. In the 6 cases from the literature, ureterectasia and hydronephrosis were detected in all patients, and intestinal pseudo-obstruction was detected in 4.@*CONCLUSION@#The possibility of lupus cystitis should be considered when lupus patients complain of urinary or bowel symptoms. Glucocorticoid and immunodepressant are effective for lupus cystitis.
Subject(s)
Adolescent , Adult , Female , Humans , Cystitis , Diagnosis , Hydronephrosis , Lupus Erythematosus, Systemic , Diagnosis , Ureter , PathologyABSTRACT
Objective To investigate the clinical significance of anti-β2 glycoprotein Ⅰ(anti-β2GP Ⅰ)antibodies in patients with systemic lupus erythematosus(SLE)and to assess their association with lupus thrombocytopenia.Methods Anti-β2GP Ⅰ antibodies were tested in 108 SLE patients(including 37thrombocytopenia patients),30 patients with rheumatoid arthritis(RA)and 30 healthy individuals by enzyme-linked immunosorbent assay(ELISA).The clinical features and laboratory findings were collected,and the associations of anti-β2GP Ⅰ antibody with laboratory findings and disease activity were analyzed.Results Sensitivities of anti-β2GP Ⅰ antibody were 19.44%(21/108)in SLE and 10%(3/30)in RA,respectively.The specificity of anti-β2GP Ⅰ antibody was 95.0% in SLE.The anti-β2GP Ⅰ antibody titers of the SLE group were significantly higher than normal group(P ＜ 0.05).There was no significant correlation between anti-β2GP Ⅰ antibodies and thrombocytopenia(r =-0.028,P ＞0.05).Anti-β2GP Ⅰ antibody was positively correlated to anticardiolipin antibody(r = 0.566,P ＜ 0.01).No associations were found between anti-β2GP Ⅰ antibody and other clinical and laboratory features.There was no statistical correlation between the level of anti-β2GP Ⅰ antibody and SLEDAI scores.Conclusions Anti-β2GP Ⅰ antibody had high specificity in SLE.There was no significant correlation between anti-β2GP Ⅰ antibodies and lupus thrombocytopenia.
ABSTRACT
Objective To investigate the feedback of eight-year program students to problem-based learning ( PBL ),and find out the existing problems and solutions.MethodsThe questionnaire survey was made in the eight-year program students.ResultsApplication of PBL could achieve good feedback.It helped to enhance the self-directed learning,expressing ability,accessing resource skill,and team spirit.ConclusionAlthough there are some problems in the practice of PBL,PBL is a good teaching method in eight-year program education.
ABSTRACT
Objective To determine the safety, pregnancy outcome and the affect on neonates in pregnant patients with systemic lupus erythematosus(SLE).Methods Sixty-two pregnant patients with SLE were evaluated retrospectively from 1999 to 2009 in our hospital. These patients were divided into two groups:selective pregnancy group and nonselective pregnancy group. The pregnancy outcomes, fetal outcomes, and lupus activity during pregnancy were compared between the two groups. The children of the SLE patients were followed up. Results There were 43 patients in the selective pregnancies group and 19 patients in nonselective pregnancies group. In the selective pregnancies group, lupus flare occurred in 10 pregnancies(23%), 35(81%)had a live birth, 7 had low birth weight infants and 7 had premature delivery; however, in the nonselective pregnancies group, lupus flare occurred in 16 pregnancies(84%), 13(68%) had abortion,6 had a live birth, but all neonates were low birth weight infants. The rates of lupus flare and pregnancy loss in the nonselective pregnancy group were higher than those of the selective pregnancy group(P＜0.05). None of the 22 children had SLE during the follow-up period. Conclusion Both selective and nonselective pregnancy may adversely affectmaternal and fetal outcomes, but patients with selective pregnancy have better outcomes either in lupus flare or maternal and fetal outcomes compared with those of the nonselective pregnancy.
ABSTRACT
Objective To explore relationship between antinucleosome antibody and desease activity of systemic lupus erythematosus(SLE). Methods Serum antinucleosome antibodies were measured by ELISA in the 88 patients with SLE. The relationship among antinucleosome antibodies, disease activity ( evaluated using SLEDAI), anti-dsDNA antibody and complements was analyzed. Results Antinucleosome antibody was positive in 70 patients with SLE (79.5%). There were correlations between the antinucleosome antibody and SLE disease activity, anti-dsDNA antibody, complement C3, erythrocyte sedimentation rate. Conclusion Antinucleosome antibody is a relatively sensitive marker in diagnosing SLE and evaluating SLE disease activity.