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Takayasu arteritis is a well-known yet rare form of large vessel vasculitis. Takayasu arteritis affects mainly women, and is most commonly seen in Japan, South East Asia, India, and Mexico, where it usually presents in the 2nd or 3rd decade of life. It is seen usually as pulseless disorder often with bruit at the stenosed arteries. Manifestations range from asymptomatic disease, to catastrophic strokes. Angiography remains the gold standard for diagnosis. Approximately half of those patients treated with steroids will respond, and half of the remaining patients respond to methotrexate; mycophenolatemofetil may be useful. Fertility is not adversely affected and pregnancy does not appear to exacerbate the disease, although management of hypertension is essential. We herewith report a rare case of an11 year old girl, who presented with left-sided hemiparesis, dysarthria, left UMN facial palsy, feeble pulses on right side, high Blood Pressure recordings and positive anti- cardiolipin antibodies. Imaging studies revealed Occluded right Common carotid artery, occluded right subclavian artery and stenotic right renal artery and MRI showed Acute Infarcts in Right Basal Ganglia and Right High Parietal Region, Hemorrhagic infarct in right MCA subcortical area.The diagnosis of Takayasu arteritis with recent cerebrovascular accident (left hemiparesis) with hypertension was made and the patient was started on steroids, anti-platelets, anti-hypertensives and physiotherapy.
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Objective:To investigate the predictive value of anticardiolipin antibody (ACA) and D-dimer (D-D) combined with risk assessment profile for thromboembolism (RAPT) for deep vein thrombosis (DVT) in elderly postoperative patients with intertrochanteric fracture of femur (IFF).Methods:The clinical data of 123 elderly patients with IFF in Suzhou Hospital Affiliated to Anhui Medical University from January 2019 to March 2022 were retrospectively analyzed. All patients underwent closed reduction intramedullary nail fixation. The patients were divided into DVT group (27 cases) and non-DVT group (96 cases) according to the presence or absence of DVT 7 d after surgery. Before surgery and 3, 5 d after operation, the ACA was detected by enzyme-linked immunosorbent assay, the D-D was detected by automatic coagulation analyzer, and RAPT was performed. The correlation among ACA, D-D and RAPT was analyzed by Spearman method. Multivariate Logistic regression was used to analyze the independent risk factors of DVT in elderly postoperative patients with IFF. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of ACA, D-D and RAPT in predicting DVT in elderly postoperative patients with IFF. The incidences of postoperative DVT in patients with different ACA, D-D and RAPT patients were compared.Results:There were no statistical difference in ACA, D-D and RAPT before operation between the two groups ( P>0.05); the ACA, D-D and RAPT 3 and 5 d after operation in DVT group were significantly higher than those in the non-DVT group, 3 d after operation: (12.44 ± 3.25) × 10 3 RU/L vs. (8.67 ± 2.81) × 10 3 RU/L, (7.29 ± 1.49) mg/L vs. (4.70 ± 1.23) mg/L and (9.79 ± 1.15) scores vs. (9.21 ± 1.32) scores; 5 d after operation: (10.28 ± 2.16) × 10 3 RU/L vs. (6.45 ± 2.04) × 10 3 RU/L, (5.49 ± 1.26) mg/L vs. (3.63 ± 1.05) mg/L and (9.57 ± 1.08) scores vs. (9.12 ± 0.70) scores, and there were statistical differences ( P<0.01 or <0.05). Since ACA, D-D and RAPT in the two groups all reached their peak 3 d after operation, this time point was selected for analysis. Three days after operation, Pearson correlation analysis result showed that ACA and D-D were positively correlated with RAPT ( r = 0.635 and 0.630, P<0.01), and ACA was positively correlated with D-D ( r = 0.657, P<0.01). ROC curve analysis result showed that the area under the curve (AUC) of ACA and D-D combined RAPT 3 d after operation in predicting DVT in elderly postoperative patients with IFF was greater than that predicted by the 3 indexes alone (0.982 vs. 0.894, 0.870 and 0.868), the optimal cut-off values were 11.48 × 10 3 RU/L, 6.75 mg/L and 9 scores. According to the optimal cut-off value of ROC curve analysis at 3 d after operation, the patients were divided into ACA low expression (≤11.48 × 10 3 RU/L, 92 cases) and ACA high expression (>11.48 × 10 3 RU/L, 31 cases), D-D low expression (≤6.75 mg/L, 99 cases) and D-D high expression (>6.75 mg/L, 24 cases), low RAPT (≤9 scores, 93 cases) and high RAPT (>9 scores, 30 cases). The incidences of postoperative DVT in patients with ACA high expression, D-D high expression and high RAPT were significantly higher than those in patients with ACA low expression, D-D low expression and low RAPT: 43.39% (15/31) vs. 13.04% (12/92), 54.17% (13/24) vs. 14.14% (14/99) and 53.33% (16/30) vs. 11.83% (11/93), and there were statistical differences ( χ2 = 16.91, 18.06 and 22.81; P<0.01). After controlling for diabetes and other factors, multivariate Logistic regression analysis result showed that ACA, D-D and RAPT 3 d after operation were independent risk factors for DVT in elderly postoperative patients with IFF ( OR = 2.156, 2.276 and 6.106; 95% CI 1.356 to 3.429, 1.240 to 4.177 and 1.564 to 23.840; P<0.01). Conclusions:The ACA, D-D combined with RAPT can improve the predictive value of DVT in elderly postoperative patients with IFF, which has important reference significance for taking timely and effective intervention measures in early clinical stage.
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OBJECTIVE: To discuss expression of antiphospholipid antibody subtypes in primary glomerular diseases. METHODS: All1021 cases who were admitted to our center between June 2015 and July 2017 in Kidney Disease Center, First Affiliated Hospital,College of Medicine, Zhejiang Universityhad renal biopsy in our center and they were praved to have primary glomerular diseases(303 cases of membranous nephropathy, 483 cases of IgA nephropathy, 76 cases of mesangial proliferative glomerulonephritis, 119 cases of minimal change nephropathy and 40 cases of focal segmental glomerulosclerosis). The levels of anti-cardiolipin(ACL) antibody subtypes(IgG, IgM and IgA)and anti-β2 glycoprotein 1(β2 GP1) antibody subtypes(IgG, IgM and IgA) were measured and compared.RESULTS: The positive rate of APA in membranous nephropathy group was highest(17.5%) and in minimal change nephropathy was lowest group(11.8%), but there were no significant differences among the groups. The positive rates of ACL in IgA nephropathy and mesangial proliferative glomerulonephritis were 11.4% and 14.5% respectively, which were significantly higher than those of anti-β2 GP1 antibody(P< 0.001, P = 0.009 respectively). The positive rate of anti-β2 GP1 antibody in membranous nephropathy group was 11.2%,significantly higher than that in the other four groups. The positive rate of ACL-IgM in mesangial proliferative glomerulonephritis group was 13.2%, which was significantly higher than that in the other four groups(P< 0.05). The positive rate of ACL-IgA in IgA nephropathy group was 5.8%, which was significantly higher than the other four groups, and there was no statistical difference(P<0.05).CONCLUSION: Antiphospholipid antibody is positive in patients with primary glomerular diseases, and the positive rate of its subtypes varies among the different pathological types of glomerulonephritis, which can be helpful to differential diagnosis and treatment of the disease.
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Objectives Anticardiolipin antibody (aCL) is an important component of antiphospholipid antibody (aPL) and a marker antibody of antiphospholipid syndrome (aPS). APL is positive in 20% to 40% of patients with systemic lupus erythematosus(SLE). This article investigated the clinical features and prognosis of SLE patients with aCL. Methods From January 1999 to December 2009, 495 cases of SLE patients detected aCL who were hospitalized for the first time in 26 hospitals in Jiangsu Province including Nanjing Drum Tower Hospital were divided into aCL-positive group and aCL-negative group according to the test results. The patients were followed up in survival status, and the demographic characteristics, affected organs, laboratory tests, treatment drugs, and prognosis were compared between two groups. Results 146 of the SLE patients in this group were positive for aCL. The proportion of women in aCL- positive group (96.6%) was significantly higher than that in aCL-negative group (90.8%), and the difference was statistically significant (P<0.05). The proportion of anemia (74.7% vs 61.3%), decreased C3(81.5% vs 71.1%), positive antinuclear antibody(97.2% vs 92.4%), and positive anti-dsDNA antibody (61.9% vs 49.6%) in aCL-positive group were significantly higher than those of aCL-negative group, and the difference was statistically significant (P<0.05). The aCL-positive group received a higher proportion of cyclophosphamide immunosuppressive therapy (39.5% vs 50.7%, P<0.05). At the end of follow-up, the mortality rate of aCL-positive group was 13.7%, and the mortality rate of aCL-negative group was 14.9% and there was no significant difference in mortality (P>0.05). Kaplan-Meier survival analysis showed that the 1-year, 5-year, and 10-year survival rates of aCL-positive group were 94.5%, 89.0%, and 82.9%, respectively, and there was no significant difference compared with aCL-negative group(P=0.776). The main causes of death in aCL-positive group were lupus encephalopathy (6 cases, 30.0%), renal failure (5 cases, 25.0%), heart failure (4 cases, 20.0%) and infection (3 cases, 15%). The main causes of death in aCL-negative group were infection (21 cases, 40.4%), lupus encephalopathy (11 cases, 21.2%) and heart failure (5 cases, 9.6%) and renal failure (4 cases, 7.7%). Conclusion SLE patients with aCL represent a high propotion in anemia, decreased C3, positive antinuclear antibody, positive anti-dsDNA antibody. There was no significant difference in disease activity and significant organ involvement between two groups. More SLE patients with aCL were treated with cyclophosphamide, and there was no significant difference in survival status between SLE patients with and without aCL during long-term follow-up.
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Objective To explore the significance of serum levels of interleukin(IL)-33,21,17, 6,the positive rates of anti-cardiolipin antibody(ACA)-IgG,ACA-IgM and anti endothelial cell antibody (AECA)-IgM in diagnosis of Kawasaki disease and prediction of coronary artery lesions. Methods Seventy children with Kawasaki disease were selected as Kawasaki disease group,and the children were divided into abnormal ultrasonic group(11 cases)and normal ultrasonic group(59 cases)according to the result of cardiac ultrasound. Fifty children with upper respiratory tract infection or bronchitis were selected as control group.The serum levels of IL-33,21,17,6 and positive rates of ACA-IgG,ACA-IgM, AECA-IgM were detected.Results The serum levels of IL-33,21,17 and 6 in Kawasaki disease acute stage were significantly higher than those in control group:(127.43 ± 10.87)ng/L vs.(69.67 ± 6.38)ng/L, (130.43 ± 11.22) ng/L vs. (87.56 ± 7.76) ng/L, (1 243.38 ± 612.08) ng/L vs. (397.26 ± 182.16) ng/L, (438.35 ± 101.78)ng/L vs.(213.74 ± 104.52)ng/L;the positive rates of ACA-IgG,ACA-IgM and AECA-IgM were significantly higher than those in control group: 37.1%(26/70)vs.8.0%(4/50),32.9%(23/70) vs.6.0%(3/50)and 34.3%(24/70)vs.8.0%(4/50),and there were statistical differences(P<0.01).The acute stage serum levels of IL-33, 21, 17 and 6 in abnormal ultrasonic group were significantly higher than those in normal ultrasonic group:(135.92 ± 11.56)ng/L vs.(123.48 ± 10.14)ng/L,(138.29 ± 11.86) ng/L vs.(128.08 ± 10.94)ng/L,(2 042.47 ± 968.43)ng/L vs.(1 096.59 ± 502.82)ng/L,(495.58 ± 103.04) ng/L vs. (402.67 ± 98.26) ng/L; the positive rates of ACA-IgG, ACA-IgM and AECA-IgM were significantly higher than those in normal ultrasonic group:7/11 vs.32.2%(19/59),8/11 vs.25.4%(15/59) and 7/11 vs. 28.8% (17/59), and there were statistical differences (P < 0.01 or <0.05). In Kawasaki disease, the acute stage serum levels of IL-33, 21, 17 and 6 were significantly higher than those in subacute stage:(127.43 ± 10.87)ng/L vs.(94.48 ± 8.56)ng/L,(130.43 ± 11.22)ng/L vs.(91.78 ± 8.03) ng/L, (1 243.38 ± 612.08) ng/L vs. (527.12 ± 236.94) ng/L and (438.35 ± 101.78) ng/L vs. (308.41 ± 144.09)ng/L,and there were statistical differences(P<0.01).Conclusions IL-33,21,17,6 and ACA-IgG, ACA-IgM, AECA-IgM participates in the process of Kawasaki disease vasculitis and coronary artery damage,which can assist the early diagnosis of Kawasaki disease and predict the coronary artery lesions.
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Objective To investigate the correlation of the anti-cardiolipin(aCL) antibodies and anti-β2 glycoprotein Ⅰ(anti-β2GPI) antibodies in missed abortion women.Methods Fourteen patients diagnosed missed abortion were chose as trial group,while 20 normal females received induced abortion in the same time as control group.Chemiluminescence method was used to measure the serum levels of IgG/IgM aCL and IgG/IgM anti-β2GPI antibodies in the two groups.Results The median levels of serum IgM aCL antibodies and serum IgM anti-β2GPI antibodies in trial group were significantly higher than those of control group(21.3(2.2-39.4)KU/L vs.6.0(1.5-10.7) KU/L,11.9(1.2-25.4) KU/L vs.1.9(1.1-4.0) KU/L;u=2.031,2.912;P ＜0.05).There were no significant differences in terms of the levels of serum IgG aCL antibodies and serum IgG anti-β2GPI antibodies between trial group and control group (P＞0.05).Conclusion There is correlation between IgM aCL as well as IgM anti-β2GPI antibodies and missed abortion,so in reducing the incidence of missed abortion,early and dynamic detection of anti-cardiolipin and anti-β2 glycoprotein I antibodies in childbearing women has a certain clinical significance.
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Objective To analyze the correlation of different antiphospholipid antibody isotypes in female infertility.Methods Selected 296 patients with female infertility and 31 normal female between May 2015 to August 2015 in Dalian Women’s and Children’s Medical Centre.All the antibodies were detected by chemilumininescence.The positiverate of antipholipid an-tibodies in female infertility patients and health controls were calculated.The concentrations of antiphospholipid antibodies in different groups were compared with Mann-Whitney U test.Results The positive rate of aCL IgG of female infertility and normal female were 0.34% and 0.00%.The positive rate of aCL IgM of female infertility and normal female were 1.35%and 0.00%.The positive rate ofβ2 GPⅠ IgG of female infertility and normal female were 0.00% and 0.00%.The positive rate ofβ2 GPⅠ IgM of female infertility and normal female were 0.34% and 0.00%.aCL IgG were differet beween female infertility and normal female (P=0.013),others had on significant difference.Conclusion Need to detect LA,combined with aCL and anti-β2 GPⅠ,exclusively diagnose APS,layed the foundation of sequential treatment.
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Objective To investigate the value of detections of anti‐nuclear antibody (ANA) combined with anti‐cardiolipin anti‐body (ACA) ,anti‐sperm antibody (AsAb) and anti‐beta 2 glycoprotein I (β2 GPI) antibody in the diagnosis of female infertility dis‐ease .Methods A total of 187 female cases of infertility (infertility group) were detected serum ANA and AsAb by the indirect im‐munofluorescence assay ,and ACA andβ2 GPI antibody by the enzyme linked immunosorbent assay (ELISA) .ANA ,ACA ,AsAb andβ2 GPI antibody also were detected in 80 females cases of normal fertility (normal group) .Results Among 187 cases of female infer‐tility ,ANA positive rate was 18 .1% (34/187) and which in the normal group was 2 .5% (2/80) .The ACA positive rate was 22 .3%(43/187) in the infertility group and 5 .0% (4/80) in the normal group ;the AsAb positive rate was 18 .7% (35/187) in the infertil‐ity group and 3 .8% (3/80) in the normal group ;theβ2 GPI positive rate was 20 .3% (38/187) in the infertility group and 3 .8% (3/80) in the normal group;the differences between the two groups had statistical significance (P<0 .05) .Conclusion Infertility is closely correlated with the in vivo existence of ANA ,ACA ,AsAb andβ2 GPI antibody ,the joint detection is conducive to find the e‐tiology of infertility and improve the clinical diagnosis rate .
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Objective To compare the results of anti-cardiolipin (ACA)measuring by two commercial available kits.Methods ACA in total of 66 serum samples were both determined by kits from Euroimmun and YHLO simultaneously,then the re-sults were analyzed comparatively and correlatively.The Euroimmun kit was applied to determination the level of ACA-IgA/G/M,and the YHLO kit determined ACA-IgG/M and anti-β2-glycoprotein I antibody (β2GPI IgG).Results The positive rate by Euroimmun kit was 37.88% (25/66),while 31.82% (21/66)was positive (one positive among ACA-IgG,IgM andβ2GPI IgG)when determined by YHLO kit,and there was no significant difference between the two kits.The accordance rate of the two kits was 87.88% (58/66).The ACA-IgA/G/M value by Euroimmun kit and the summation of ACA-IgG, IgM andβ2GPI IgG by YHLO kit showed well linear correlation (r 2 =0.892,P <0.01).Conclusion Results from the two kits were consistent and correlated well,and they are suitable for the clinical application;these two kits have their own char-acteristics,which could be used by individual or combination accordingly.
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Introducción: el síndrome antifosfolípidos es una enfermedad de reciente aparición, por lo que no se cuenta con una prevalencia real, sin embargo afecta aproximadamente a 0,5% de la población, principalmente a mujeres; siendo una importante causa de trombosis arterial, venosa o de pequeños vasos y alteraciones obstétricas. Objetivo: hacer una revisión para integrar el conocimiento de los mecanismos implicados en las vías patológicas del síndrome antifosfolípidos que involucran anticuerpos y sustancias endógenas, para que sea usado en el diagnóstico y tratamiento de esta enfermedad. Conclusiones: en el síndrome antifosfolípidos participan varios componentes, entre ellos el anticuerpo anti-Beta2-Glicoproteína1, anticoagulante lúpico, anticuerpos anti-cardiolipina, anticuerpos anti-serin proteasas, anticuerpos anti-anexina A5, sistema del complemento y factor tisular, que al realizar su acción son los causantes de las manifestaciones trombóticas y alteraciones obstétricas. El entender los mecanismos de acción de dichos componentes, puede contribuir al mejoramiento diagnóstico y creación de herramientas terapéuticas para disminuir la mortalidad y morbilidad causada por el síndrome antifosfolípidos. (MÉD.UIS. 2014;27(1):43-50).
Introduction: the antiphospholipid syndrome is an emerging disease, so there is no real prevalence, however affects approximately 0.5% of the population, mainly women , being a major cause of arterial , venous, or small vessel and obstetric disorders. Objective: to revise to integrate knowledge of the mechanisms involved in pathological pathways involving antiphospholipid antibody syndrome and endogenous substances, to be used in the diagnosis and treatment of this disease. Conclusions: antiphospholipid syndrome involves several components, including the anti - Beta2 - Glicoproteina 1, lupus anticoagulant, anticardiolipin antibodies, anti- serine proteases, antiannexin A5 antibodies, complement system and tissue factor, that doing their actions are causing thrombotic manifestations and obstetric disorders. Understanding the mechanisms of action of these components can contribute to improved diagnostic and therapeutic tool created to reduce mortality and morbidity caused by antiphospholipid syndrome. (MÉD.UIS. 2014;27(1):43-50).
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Humans , Antiphospholipid Syndrome , Thrombosis , Lupus Coagulation Inhibitor , Antibodies, AnticardiolipinABSTRACT
Objective To explore the relationship between serum anti - cardiolipin antibodies( ACA ) and recurrent cerebral infarction( RCI),and to provide the clinical evidence for the prevention and treatment of RCI. Methods One hundred and ten patients with RCI,120 patients with primary cerebral infarction( PCI)and 150 healthy controls were recruited. Serum ACA was detected using quantitative enzyme linked immunosorbent assay( ELISA)and the positive rate of ACA was compared between these three patient groups. Results The positive rate of serum ACA of RCI group (31. 82%)was higher than that of PCI group( 15. 00%)( P <0. 05 ). Compared with patients above 50 years old (11. 56%),the patients under age of 50 had a higher positive rate of ACA( 57. 89%)( P <0. 05 ). There was no significant difference between males( 22. 52%)and females( 23. 53%) in positive rate of ACA( P > 0. 05 ). The recurrence rate(56. 25%)of ACA positive patients was higher than that of ACA negative patients(29. 79%)after one year follow up(P<0. 05). Conclusion Higher positive rate of serum ACA is observed in RCI patients. The PCI patients with high positive rate of serum ACA has an increased susceptibility for RCI. ACA detection is important for prediction and clinical intervention of the recurrence of cerebral infarction.
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Objective To investigate the relationship between the autoantibody detection and abortion of pregnant women.Meth-ods The dot immunogold method,indirect immunofluorescence and enzyme-linked immunosorbent assay(ELISA)were used to de-tect serum anti-double stranded DNA antibody (dsDNA),anti-smooth muscle antibody (SMA),antinuclear antibody (ANA),anti-endometrial antibody (EMAb),anti-cardiolipin antibody(ACA),anti-sperm antibody (ASAb),anti-ovarian antibody(AoAb).Re-sults Compared with healthy pregnant women,the values of EMAb,ACA,AoAb,ANA and SMA in abortion pregnant women were increased with statistical differences (P <0.05).Conclusion EMAb,ACA,AoAb,ANA and SMA have high correlation with abortion of pregnant women.Confirming the causes of unexplained abortion and prenatal screening are especially important for the pregnant women in the border area.
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Antiphospholipid antibodies are a family of autoantibodies directed against certain phospholipids or phospholipid-binding proteins. Antiphospholipid antibody syndrome can occur as a secondary event to an underlying autoimmune disease, most commonly systemic lupus erythematosus and also occur in certain infectious diseases and drug reactions. We experienced a patient with Kawasaki disease who had anticardiolipin antibodies accompanied by coagulation abnormalities. A 4-month-old female patient was admitted due to fever, irritability, lymph node swelling on the right submandibular area and maculopapular skin rashes on trunk and both extremities. She had prolonged activated partial thromboplastin time (aPTT). Further investigations revealed a positive anticardiolipin antibody detected by ELISA. She had right lateral sinus thrombosis on parieto-occipital area on brain MRI and thrombotic microangiopathy, resulting in necrosis of toe. She showed considerable improvement in affected skin after dexamethasone treatment for 3 weeks. Thrombosis was resolved completely 2 months later.
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Female , Humans , Infant , Antibodies, Anticardiolipin , Antibodies, Antiphospholipid , Antiphospholipid Syndrome , Autoantibodies , Autoimmune Diseases , Brain , Communicable Diseases , Dexamethasone , Enzyme-Linked Immunosorbent Assay , Exanthema , Extremities , Fever , Lateral Sinus Thrombosis , Lupus Erythematosus, Systemic , Lymph Nodes , Magnetic Resonance Imaging , Meningitis , Mucocutaneous Lymph Node Syndrome , Necrosis , Partial Thromboplastin Time , Phospholipids , Skin , Thrombosis , Thrombotic Microangiopathies , ToesABSTRACT
Objective To study the relationship between anticardiolipin antibody(ACA) and cerebral infarction(CI).Methods The positive rate of serum ACA were determined by enzyme linked immunosorbent assay(ELISA) in 137 patients with CI at first day,first,second,third and fourth week after the onset of the disease.The results were compared with transient ischemia attach(TIA) group,intracerebral hemorrhage(ICH) group and normal control group.Results The positive rate of ACA in CI group(64.9%) was significantly higher than TIA group(24.6%),ICH group(33.6%) and normal control group(17.6%)(all(P