Increased human neutrophil lipocalin and its clinical relevance in adult-onset Still's disease / 中华医学杂志(英文版)

BACKGROUND@#Human neutrophil lipocalin (HNL) has been used extensively to differentiate acute bacterial infection from febrile diseases as a biomarker to reflect the activation of the neutrophil. The serum HNL levels in the adult-onset Still's disease (AOSD) patients with and without infection, as well as the healthy controls (HCs), were analyzed statistically in this study to evaluate the value of HNL for the diagnosis of AOSD.@*METHODS@#A total of 129 AOSD patients were enrolled, from whom blood samples were drawn and the AOSD diagnosis was confirmed through the review of the medical records, where the systemic score, demographic characteristics, clinical manifestations, and laboratory parameters were also collected for the patients; in addition, a total of 40 HCs were recruited among the blood donors from the healthcare center with the relevant information collected. The HNL test was done for the blood samples with the enzyme-linked immunosorbent assay and the analyses were done for the correlations of HNL with clinical manifestations and diagnostic effectiveness.@*RESULTS@#The serum HNL increased significantly in the patients with only AOSD as compared with that in the HCs (139.76 ± 8.99 ng/mL vs . 55.92 ± 6.12 ng/mL; P  < 0.001). The serum HNL level was correlated with the white blood cell (WBC) count ( r  = 0.335, P  < 0.001), neutrophil count ( r  = 0.334, P  < 0.001), erythrocyte sedimentation rate ( r  = 0.241, P  = 0.022), C-reactive protein ( r  = 0.442, P  < 0.0001), and systemic score ( r  = 0.343, P  < 0.0001) in the AOSD patients significantly. Patients with fever, leukocytosis ≥15,000/mm 3 , and myalgia in the HNL-positive group were observed relatively more than those in the HNL-negative group ( P  = 0.009, P  = 0.023, and P  = 0.007, respectively). HNL was a more sensitive indicator than ferritin and C-reactive protein (CRP) to differentiate the AOSD patients with bacterial infection from AOSD-only patients, and the Youden index was 0.6 for HNL and 0.29 for CRP.@*CONCLUSION@#Serum HNL can be used as a biomarker for the diagnosis of the AOSD, and HNL is also observed to be associated with the disease activity.

The relationship between serum aggrecan catabolic fragments and joint Sharp assessment in patients with rheumatoid arthritis / 中华风湿病学杂志

Objective To investigate the relationship between abnormal metabolism of aggrecan and joint destruction in patients with rheumatoid arthritis (RA).Methods 140 RA patients with duration less than 24 months were enrolled into this study.The study also included 100 normal controls and 95 patients with other rheumatic diseases.Three monoclonal antibodies (5D4,7D4 and BC-3) of aggrecan were used to detected aggrecan catabolic fragments in serum of RA patients and the other two groups of controls by enzyme linked immunosorbent assay (ELISA),and the correlation of aggrecan catabolic fragments with joint damage were analyzed.Sharp evaluation of hand joints in RA patients were performed at baseline and after one year follow-up.Calculating the area under the receiver operating characteristic curve (ROC) was used to evaluate the sensitivity and specificity of aggrecan catabolic fragments detected in serum of RA patients.Results Both levels of 5D4 fragment and BC-3 fragment of RA group were higher than those of normal control [5D4 of RA:(5.8±2.1) ng/μl,normal control:(2.2±1.3) ng/μl;BC-3 of RA:(11.1±3.4) ng/μl,normal control:(5.0±2.1) ng/μl,F=38.65,24.07,P＜0.001).There was no difference in 7D4 fragment among three groups (F=0.589,P=0.478).Both two fragment levels of RA patients with anti-CCP positive were greater than those patients with anti-CCP negative [5D4:(5.6±1.3) ng/μl vs (4.4±1.1) ng/μl,F=21.23,P＜0.01;BC-3:(12.2±3.9) ng/μl vs (9.3±2.8) ng/μ1,F=27.14,P＜0.01].Linear Regression showed that serum fragments detected by 5D4 and BC-3,and anti-CCP positive were risk factors for Sharp deterioration after one year follow-up.The sensitivity and specificity of combined detection of two aggrecan fragments in serum of RA patients for the prediction of joint Sharp were 56.5％ and 84.2％ respectively.Positive predictive value and negative predictive value are 74.3％ and 70.6％.respectively.Application of areas of ROC to identify the best evaluation of Sharp was 0.798.Conclusion There is positive correlation between aggrecan catabolic fragments in serum and joint Sharp evaluation of RA patients.Detection of aggrecan catabolic fragments in RA patients may predict early joint destruction.

Arthritis, fever, and wheeze / 中华风湿病学杂志

ObjectiveTo explore the diagnostic and differential diagnostic points in a patient with rheumatoid arthritis (RA) complicated with fever and pulmonary diseases. MethodsFull clinical analysis was performed for a 55-year old patient with arthritis, fever, and wheeze. ResultsThe clinical pictures of the patient were consistent with those of RA. Computed tomography(CT) revealed interstitial lung diseases and intrapulmonary cavities. Antifungal agents were given experimentally, and the intrapulmonary cavities disappeared finally, thus the patient was diagnosed as RA, concurrently complicated with interstitial lung disease and pulmonary fungal infection. ConclusionThe possibility of pulmonary fungal infection should be considered in RA patients who presented with fever and intrapulmonary cavities.

Clinical study on the onset of systemic lupus erythematosus in 20 postmenopausal patients / 中华老年医学杂志

Objective To study the clinical characteristics of the onset of systemic lupus erythematosus(SLE) in postmenopausal patients. Methods The clinical features and prognosis of 20 SLE patients whose onset was at least one year after menopause,and 70 patients with the onset during normal menstruation and 43 male patients between 1992 and 2003 were comparatively analyzed. Results The onset of SLE was seen after menopause in 20 out of 699 (2.9%) female patients. The average age at the onset of the disease was 55 years with a peak from 50 to 59. The common clinical manifestations were arthritis,lassitude,fever,alopecia,malar rash,cardiac impairment and weight loss,while laboratory abnormalities were high ESR,decreased C3,ANA≥1∶80,hypergammaglobulinemia and positive anti-RNP antibody. As compared with normal menstruation onset group,the postmenopausal onset group was more likely to have weight loss( P

Clinical analysis of 20 patients with relapsing polychondritis / 中华风湿病学杂志

Objective To enhance the understanding of relapsing polychondritis (RPC).Method Clinical features,laboratory studies and prognosis of RPC in 20 patients were analyzed.Results The average age at the beginning of disease was 53 4 years (range from 35 to 86).The average course from initiation of clinical symptoms to diagnosis was 1 1 years.Of patients,90% had auricular chondritis,80% had respiratory system involvement,75% had nasal chondritis and 4 patients had severe tracheobronchial chondritis.Involvement in joints,skin,cardiovascular and neurotic system also existed in various frequencies,and 20% of the patients were associated with other rheumatic or autoimmune diseases.Conclusion Extensive laryngo tracheobronchial disease is a vital signal in RPC.Early diagnosis and treatment with corticosteroid and immunosuppressant can improve the prognosis.

A report of 3 patients with reflex sympathetic dystrophy and literature review / 中华风湿病学杂志

Objective To enhance the understanding of the clinical features,diagnosis,treatment and prognosis of reflex sympathetic dystrophy (RSD).Method Three patients with RSD in PLA General Hospital were analyzed.Results In the three patients the symptoms appeared following an injury,they had severe pain,swelling,limited range of motion,vasomotor instability,skin changes,patchy bone demineralization,and increased scintigraphic uptake in the peripheral joints of involved extremities.Two of them had shouder hand syndrome and one had obvious skin thickening.The patients showed better responses after the treatrment of physiotherapy,nonsteroidal antiinflammatory drugs,corticosteroids and tricyclic antidepressants.Conclusion Early diagnosis is very important and appropriate treatment must be initiated as early as possible for RSD patients.

Imaging Diagnosis of Reflex Sympathetic Dystrophy / 实用放射学杂志

Objective To investigate the value of imaging in the diagnosis of reflex sympathetic dystrophy(RSD).Methods The clinical manifestations and imaging findings of RSD in five patients were analyzed.Results The onset of clinical symptoms of patients was followed by an injury in all cases.Severe pain,swelling,limited range of motion and vasomotor instability were main complaints.Patchy bone demineralization could be found both on plain radiographs and CT.CT scan was superior to plain radiographs in detecting bone demineralization.Increased scintigraphic uptake in the involved extremities were demonstrated in all four patients who examined by bone scintigraphy.Bony erosions which were not easily visible on plain radiographs could be clearly seen on MRI in one patient at early stage.Conclusion Patchy bone demineralization on plain radiographs and CT is the most outstanding imaging finding in RSD.Bone scintigraphy and MRI can help early in diagnosis of the disease.