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Resumen: ANTECEDENTES: el lupus eritematoso sistémico es una enfermedad autoinmunitaria de origen multifactorial en la que se afectan múltiples órganos. OBJETIVO: establecer las principales características de los pacientes con lupus eritematoso sistémico tratados en el servicio de Medicina Interna, las causas de ingreso, el grado de actividad de la enfermedad y la evolución posterior a su ingreso al hospital. MATERIAL Y MÉTODO: estudio descriptivo y retrospectivo de pacientes con diagnóstico de lupus eritematoso sistémico, ingresados durante el periodo del 1 de enero de 2013 al 30 de junio de 2016 en el servicio de Medicina Interna del Hospital Escuela Universitario de Tegucigalpa, Honduras. RESULTADOS: se estudiaron 78 pacientes del sexo femenino y 5 masculinos, con relación aproximada de 16:1; el promedio de ingresos hospitalarios por paciente fue de 1.19. Se encontró un índice MEX-SLEDAI promedio de actividad al ingreso de 7.5 ± 4.6 puntos. El promedio de estancia hospitalaria fue de 12.4 ± 11.7 días, en 61% de los casos la duración de la hospitalización fue mayor de 7 días, en este grupo se encontró un valor promedio de actividad lúpica de 8.5 ± 4.4 puntos. La causa más frecuente de ingreso hospitalario fue la actividad de la enfermedad 58%, seguida de procesos infecciosos 24%. CONCLUSIONES: el lupus eritematoso sistémico se diagnostica comúnmente en pacientes jóvenes principalmente del sexo femenino; sin embargo, cuando afecta a pacientes masculinos, la actividad de la enfermedad suele ser más severa. La actividad lúpica fue la principal causa de ingreso.
Abstract: BACKGROUND: Systemic lupus erythematosus SLE is an autoimmune pathology of multifactorial etiology where multiple organ involvement occurs. OBJECTIVE: To establish the main characteristics of patients with systemic lupus erythematosus treated at Internal Medicine service, their causes of entering, degree of disease activity and evolution posterior to hospitalization. MATERIAL AND METHOD: A descriptive and retrospective study of patients diagnosed with systemic lupus erythematosus admitted during the period from January 1st 2013 to June 30 2016 at the Internal Medicine Service of the Hospital Universitario de Tegucigalpa, Honduras. RESULTS: We studied 78 female and 5 male patients, establishing a ratio of approximately 16:1, the average hospital admission per patient was 1.19. We found an average MEX-SLEDAI of activity at the entrance of 7.5 ± 4.6 points. The average hospital stay was 12.4 ± 11.7 days, in 61% of cases duration of more than 7 days was presented, in this group an average value of lupus activity of 8.5 ± 4.4 points was found. The most frequent cause of hospital admission was the activity of the disease 58%, followed by infectious processes 24%. CONCLUSIONS: Systemic lupus erythematosus is commonly diagnosed in young female patients, but when it occurs in male patients, the disease activity is usually more severe. Lupic activity was the main cause of hospitalization.
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Los auto anticuerpos contra la proteína P ribosomal (anti-P ribosomales) se presentan en aproximadamente el 15% de los pacientes con lupus eritematoso sistémico (LES). Estos anticuerpos fueron inicialmente asociados con psicosis lúpica y enfermedad neuropsiquiátrica. Posteriormente se reconoció su asociación con alto riesgo de compromiso renal y hepático. Objetivos: evaluar la coexistencia serológica y clínica de anticuerpos anti-P ribosomal y anti-DNA en pacientes con LES con compromiso renal y neuropsiquiátrico. Materiales y métodos: casos: 12 pacientes con lupus neuropsiquiátrico (cambios conductuales 6, depresión 4, alucinaciones 3, alteración cognitiva 2, convulsiones 2 y psicosis 2). Controles: 13 pacientes con actividad por LES sin evidencia de manifestaciones neuropsiquiátricas. Todos los pacientes estuvieron activos para el tiempo de la evaluación. Los anticuerpos anti-P ribosomal fueron determinados por ELISA y los anti-dcDNA por el método de Crithidia luciliae. La función renal fue valorada por medición de creatinina y el compromiso renal con uroanálisis. Resultados: la edad media fue de 39 años, 2 hombres / 23 mujeres. Ocho casos (66,6%) y seis (46,1%) controles tenían compromiso renal. El 20% de los pacientes fueron positivos para anti-P ribosomal (5/25 pacientes: 2 controles y 3 casos). El 36% de los pacientes tenían anticuerpos anti-dsDNA (30,7% controles y 41,6% casos). La presencia de anticuerpo P ribosomal estuvo asociada con anti-dcDNA (p = 0,002) y con nefritis lúpica (p = 0,046), pero no hubo asociación entre el anti-P ribosomal y las manifestaciones neuropsiquiátricas (p = 0,645). Conclusiones: la presencia de anticuerpos anti-P ribosomal está asociada con anti-dcDNA y nefritis lúpica. Este estudio no encontró asociación estadísticamente significante entre anti-P ribosomal y manifestaciones neuropsiquiátricas del LES.
Summary The ribosomal P protein autoantibodies are present in approximately 15% of patients with Systemic Lupus Erythematosus (SLE). These antibodies were initially associated with lupus psychosis and neuropsychiatric diseases. Posteriorly, they were associated to a higher risk of renal and liver involvement in patients with SLE. Objective: to evaluate the serologic and clinic coexistence of ribosomal P protein autoantibodies and anti-dsDNA in patients with SLE with renal and neuropsychiatric manifestations. Materials and Methods: cases: 12 patients with neuropsychiatric and renal involvement (behavior changes 6, depression 4, hallucinations 3, cognitive impairment 2, seizures 2 and psychosis 2). Controls: 13 patients with active SLE, without evidence of neuropsychiatric manifestations. SLE was active in all patients during the process of evaluations. The anti-ribosomal P protein antibodies were determined by ELISA and the dsDNA antibodies by Crithidia luciliae´s immunofluorescence test. The renal function was evaluated by serum creatinin and urinalyses. Results: the median age was 39 years, 2 men/23 women. 8 cases (66.6%) and 7 controls (53.8 %) have renal involvement. 20% of patients were positive for anti P-ribosomal antibodies (5/25 patients: 2 controls and 3 cases). 36% of patients have anti dsDNA antibodies (30.7% controls and 41.6% cases). The presence of anti-ribosomal P protein antibodies was associated with anti dsDNA antibodies (p = 0.002) and with lupus nephritis (p = 0.046), but no association between ribosomal P protein autoantibodies and neuropsychiatric manifestations was found (p = 0.645). Conclusions: the P-ribosomal antibodies are associated with anti-dsDNA and lupus nephritis. This study did not show statistically significant associations between ribosomal P protein autoantibodies and neuropsychiatric manifestations in patients with SLE.
Subject(s)
Humans , Neuropsychiatry , Kidney , Lupus Erythematosus, Systemic , Antibodies , Psychotic Disorders , Behavior , Cognitive DysfunctionABSTRACT
Objective:To investigate the correlationship between levels of erythrocyte receptor type1(E-CR1) and disease activity and abnormal criteria of immunology in systemic lupus erythematosus (SLE)and to study the E-CR1 levels in pathogenesis of SLE.Methods:The fluorescence intensity in sera from 72 patients with SLE and 20 cases of normal controls was detected by flucytometry.Complement(C3,C4),immunoglobulins(IgG,IgA and IgM),gammaglobulins(?-G),erythrocyte sediment rate(ESR) and blood cell counts,including white blood cell(WBC),red blood cell(RBC),hemoglobin(HGB),hematocrit(HCT),mean corpuscular volume(MCV)and platelet(PLT) were detected at the same time.The scoring instruments of systemic lupus activity measure (SLAM) were used to evaluate disease activity.Results:The E-CR1 levels in patients with SLE were lower significantly than that in normal controls (P
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Objective:To investigate influence of Fludarabine to lupus activity of lupus mice and the effectiveness and safety of Fludarabine on the treatment of BXSB lupus mice and their possible methanism Methods:Fludarabine of 30 mg/(m 2?d) was injected into BXSB by tail vein,3 days continuously Results of treatment was observed through counting number of peripheral blood WBC Anti ds DNA and anti nuclear antibody in BXSB serum was measured by ELISA Pathologic transformation of kidney or urine protein was measured by immunofluorescence or urine protein test paper after treated by Fludarabine Expression of CD4 +Fas +?CD8 +Fas +?CD45RO + Fas + on T lymphocyte were measured by flowcytometry Results:The number of peripheral blood WBC of BXSB mice began to decline from the third day after treated by Fludarabine The lowest value 〔0 5?0 2)?10 9 L -1 〕of the number of peripheral blood WBC appeared on the seventh day and on the nineteenth day the number of peripheral blood WBC was up to 1 0?10 9 L -1 after treated by Fludarabine The falling of anti ds DNA and anti nuclear antibody in BXSB serum appeared on the fourteenth and twentieth one day after treated by Fludarabine, respectively Reduction of from +～++ turning?kindey immunofluorescence were 72 7% in group of Fludarabine Reduction of protein urine from ++～+++ turning ?～ - appeared on the twentieth one and twentieth eight days Reduction of expression of CD4 +Fas +?CD8 +Fas +?CD45RO + Fas + on T lymphocyte was obvious after treated by Fludarabine Conclusion:Fludarabine can evidently reduce the serum level of anti ds DNA and anti nuclear antibody of BXSB and reduce injury of kidney and formation of protein urine So Fludarabine may have good curative effect to severe SLE Fludarabine can reduce expression of CD4 +Fas +?CD8 +Fas +?CD45RO + Fas + on T lymphocyte,which may be one of methanism of Fludarabine to SLE