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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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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 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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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 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 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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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.