The relationship of leptin and adiponectin with insulin resistance in nonalcoholic fatty liver disease / 中华肝脏病杂志

<p><b>OBJECTIVES</b>To investigate the serum leptin and adiponectin levels in nonalcoholic fatty liver disease (NAFLD) patients, and their relationship with insulin resistance.</p><p><b>METHODS</b>A total of 120 cases were enrolled and divided into two groups: NAFLD group (n = 60) and normal control group (n = 60). The serum levels of leptin and adiponectin were measured by ELISA. The body mass index (BMI), waist-to-hip ratio (WHR), triglyceride (TG), total cholesterol (Tchol), high-density lipoprotein cholesterol (HDL-C) , aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), fasting blood glucose (FBG) and HOMA-IR (homeostasis model assessment insulin resistance) were detected and analyzed.</p><p><b>RESULTS</b>Compared with control group, the serum leptin level in NAFLD group was Significantly higher [(12.37+/-1.99) microg/L vs (5.20+/-1.03) microg/L, P less than 0.01], while the serum adiponectin level was significantly lower [(12.69+/-2.83) mg/L vs (22.83+/-4.61) mg/L, P less than 0.01]. HOMA-IR was also much higher in NAFLD group than that in control group[(4.86+/-0.63) vs (1.91+/-0.41), P less than 0.01]. Logistic regression analysis showed that leptin was positively correlated with WHR (beta value = 8.175, P less than 0.01), HOMA-IR (beta value = 0.974, P less than 0.01 ), FBG (beta value = 0.564, P less than 0.01 ). In contrast, adiponectin inversely associated with HOMA-IR (beta value = -0.495, P less than 0.01 ) and BMI (beta value = -0.314, P less than 0.01) respectively.</p><p><b>CONCLUSION</b>The increased serum leptin level and decreased serum adiponectin level in NAFLD patients independently associated with HOMA-IR.</p>

Macrophage activation syndrome in Chinese children with systemic onset juvenile idiopathic arthritis / 中华儿科杂志

<p><b>OBJECTIVE</b>To review and analyze the clinical features, treatment, and outcome of macrophage activation syndrome (MAS) in children with systemic onset juvennil rheumatoid arthritis (SOJRA).</p><p><b>METHOD</b>Retrospective review and analysis were performed on cases with MAS from a prospectively collected database of children with SOJRA from the year of 2003 to 2006 in the Hospital.</p><p><b>RESULTS</b>Twenty four patients (21 boys, 3 girls) were diagnosed as having MAS with SOJRA. Mean age of the patients with MAS at diagnosis was 7 years, and the duration prior to diagnosis of MAS was 12 months. No trigger factors were found except in one case whose MAS was triggered by use of methotrexate and in another by parvovirus B19 infection. High grade fever, new onset hepatosplenomegaly and lymphadenopathy, pancytopenia, liver dysfunction were common clinical features in all the 24 cases (100%). Bleeding from skin, mucous membrane and gastrointestinal tract were noted in 9 cases (38%). Twelve (50%) cases had CNS dysfunction (high intracranial pressure, seizure and coma). Six cases (25%) developed ARDS. One patient suffered from renal damage. The laboratory test revealed elevated live enzymes and ferritin, decreased value of ESR, albumin, complete blood count and fibrinogen in all the 24 cases. Bone marrow examination supported the diagnosis of definite hemophagocytosis in the 24 cases. Lymph node biopsy was done for one case and histopathological examination showed that the node was full of activated macrophage. As to treatment, five cases only received high dose steroids (three of them died), 14 cases were treated with high dose steroids plus cyclosporine (one died), two were treated with steroids plus cyclosporine and etoposide (none died). The causes of deaths were ARDS and CNS involvement. In three of the cases who died, treatment was given up by their parents.</p><p><b>CONCLUSIONS</b>MAS is a rare and potentially fatal complication of SOJRA. Most of our patients were male. Bone marrow studies support the diagnosis. CNS involvement and ARDS were poor prognostic signs. Early diagnosis and aggressive therapy are essential.</p>

Diagnostic significance of combined testing of anti-cyclic citrullinated peptide antibody and hidden rheumatoid factor immunoglobulin M in patients with juvenile rheumatoid arthritis / 实用儿科临床杂志

Objective To explore the early diagnostic significance of anti-cyclic citrullinated peptide(CCP) antibody and hidden rheumatoid factor immunoglobulin M(HRF-IgM) detected by ELISA in patients with juvenile rheumatoid arthritis(JRA). Methods The synthesized CCP was used as the antigen to detect anti-CCP antibody. Anti-CCP antibody and HRF-IgM were detected dynamically in 27 patients with early diagnosed JRA and their specificity and sensitivity were determined for early diagnosed JRA by calculating the positive predicting value (PPV) and negative predicting value (NPV). Results The total positive rate of anti-CCP antibody and HRF-IgM were 58.5 % and 65.0 % respectively in patients with JRA. The sensitivity of HRF-IgM was more predominant than that of anti-CCP antibody. There was a positive correlation between the positive rate of antibodies and the subtype of JRA. The specificity of anti-CCP antibody for predicting early JRA was superior to that of HRF-IgM. When using these two tests in combination, the PPV predicting rate of early JRA was 93.7 % . Conclusions Both anti-CCP antibody and HRF-IgM are elevated in patients with JRA, which show positive correlations with the subtype of the disease. The specificity of anti-CCP antibody testing is considerably higher for diagnosing early JRA, and when it was used together with HRF-IgM testing, the PPV for JRA can be raised further.

Association of HLA-A, B, and DR haplotypes with genotype in Chinese children with systemic lupus erythematosus / 中华儿科杂志

<p><b>OBJECTIVE</b>Development of systemic lupus erythematosus (SLE) is not only associated with single loci of HLA gene, but also possibly related to certain haplotypes and genotypes of MHC. In the present study the authors explored association of HLA-A, B, DR haplotype and genotype with SLE in Chinese children, analyzed a large family with multiple SLE patients and genetic origin of SLE patients with HLA-DRB1 * 15, to discover the influence of linkage disequilibrium of HLA gene on SLE.</p><p><b>METHODS</b>HLA-A, B, DR alleles were tested in 53 patients with SLE and 40 cases with their parents, 35 patients with SLE and HLA-DRB * 15 positive and 27 cases with their parents, a large family with SLE (18 members of three generations) and also 78 normal controls and 43 cases with their parents by microlymphocytotoxicity test and polymerase chain reaction - sequence specific primers (PCR-SSP). HLA-A, B, DR haplotype and genotype of SLE patients and controls were statistically calculated. The SLE patients with HLA-DRB1 * 15 and controls were analyzed for either the gene originated from the paternal or the maternal side.</p><p><b>RESULTS</b>The variety of the haplotype in patient group (64/80) was less than that in control group (74/86). Only 9 haplotypes were found common between the patient group and control group. The frequency of the haplotype HLA-A9B40DRB1 * 15 was significantly higher in patient group than that in control group (P < 0.05), RR was 10.726 0. Five members of the large family had haplotype A9B40DRB1 * 15, 2 of them were patients with SLE, 1 of them was positive for ANA and had Raynaud's phenomenon and 2 of them were normal. The rest of the family members were normal. The frequency of genotypes DRB1 * 09/DRB1 * 15 and DRB1 * 03/DRB1 * 15 in SLE group was significantly higher than that of control group (P < 0.05), RR was 7.772 7 and 14.272 7, respectively. The number of SLE children with gene HLA-DRB1 * 15 derived from their fathers was significantly higher than that of the children with the gene derived from the mothers.</p><p><b>CONCLUSION</b>These findings suggested that haplotype HLA-A9B40DRB1 * 15 and genotypes HLA-DRB1 * 09/DRB1 * 15, HLA-DRB1 * 03/DRB1 * 15 were correlated with SLE. The predisposition of multiple loci seems to have an additive effect. The children with their gene HLA-DRB1 * 15 derived from their fathers might more easily suffer from SLE than those with the gene derived from their mothers, the underlying mechanism needs further studies.</p>

Clinical Application of Lupus Anticoagulant Level Detection in Children with Systemic Lupus Erythematosus or Idiopathic Thrombocytopenic Purpura / 实用儿科临床杂志

Objective To investigate the relativity of the lupus anticoagulant(LAC), anticadiolipin antibody(aCL) - IgG,aCL-IgM,aCL-IgA levels and clinical symptoms of systemic lupus erythematosus (SLE), and to determine the significance of the LAC level in the prognosis of idiopathic thrombocytopenic purpura (ITP) by detecting the LAC and aCL-IgG, IgM,IgA levels in 310 children with SLE and 249 children with ITP. Methods Kadin-cephalin clotting time(KCCT) and correcting test to detect the plasma LAC level and to the serum aCL- IgG, IgM, IgA levels with enzyme - linked immunosorbent assay. Results In SLE group, there were 66.1% patients with higher LAC among whom 45.9% patients suffered from lupus nephritis , aCL subantibody level elevated in 46.8% patients (90.2% IgG and/or IgM) serum; 46.9% and 11.7% patients suffered from central nervous system diseases and blood diseases with SLE respectively. In ITP group, 36.2% patients with LAC positive were diagnosed as SLE by detecting the serum antinuclear antibody level, and 7.6% suffered from SLE subsequently in the period of 2 months to 2.4 years. Conclusions The LAC and aCL subantibody levels may have an important relativity with the clinical symptoms of SLE. The LAC is the predominant pathologic autoantibody in patients with lupus nephritis, and the aCL subantibody( IgM, IgG) levels were related to lupus thromboangiitis. The IAC level of children with ITP should be monitored in order to determine the prognosis of the disease as soon as possible.