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Objective:To improve the level of clinical diagnosis and treatment by analyzing the clinical features and relevant factors of cryptococcosis neoformans in patients with connective tissue disease(CTD).Methods:Twelve patients with CTD and cryptococcosis neoformans infection in Peking University People's Hospital from January 2010 to April 2021 were retrospectively enrolled. Clinical and laboratory data, treatment and outcome were collected and analyzed. Independent sample t-test or Rank-sum test was used. Results:The age of the patients ranged from 18 to 85 years old(mean 51 years old), all of whom were female. None of them were exposed to pigeons and their feces. Of the 12 patients, 3 patients suffered from rheumatoid arthritis, 7 patients had systemic lupus erythematosus, 1 patient was diagnosed with primary Sj?gren 's syndrome, and 1 patient was diagnosed as undifferentiated connective tissue disease. Four cases were cryptococcal meningitis, 8 were pulmonary cryptococcosis. None of the 12 patients had immunodeficiency virus infection. All 12 patients were given glucocorticoid alone or combined with immunosuppressive or biological agents. All were detected with positive cryptococcus neoformans antigen in serum; 6 got lumbar puncture, 2 cases were positive for ink stain, cerebrospinal fluid (CSF) culture were positive in 2, in whom 3 had high intracranial pressure, in which the highest one was more than 600 mmH 2O (1 mmH 2O=0.009 8 kPa); 7 cases underwent lung biopsy. Among these patients, all were positive for cryptococcosis neoformans in lung tissue pathological examination; 6 had the number of peripheral lymphocytes less than 1.0×10 9/L, and 2 were detected for the number of CD4 + T cell, which was significantly decreased. As for the initial anti-fungal drug therapy, all cases were treated with fluconazole intravenously; 2 were treated with combined amphotericin, 1 was treated with combined fluorocytosine, 1 was treated with amphotericin and fluorocytosine. Then oral flu-conazole was prescribed as sequential therapy. The whole treatmentcourse ranged from 4 to 21 months. Eleven patients were cured, and 1 was relieved. Conclusion:Patients with connective tissue disease complicated with cryptococcus neoformans infection have atypical clinical symptoms. Treatment with immunosuppressive drugs and glucocorticoids are related causes. Patients with decreased peripheral blood lymphocytes, especially CD4 + T cell, are more susceptible to infection. Early diagnosis and timely treatment are the key to improve the prognosis and cure of the disease.
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Objective:To investigate the role of conjunctival impression cytology in the diagnosis of Sj?gren's syndrome (SS) and the immunological factors influencing conjunctival lesions.Methods:A total of 57 patients complaining about dry eye were collected, including 38 patients with primary Sj?gren's syndrome (pSS) and 19 patients with non-SS. Conjunctival impression cytology tests were performed for all patients, and they were scored by the Nelson method. Thirty-one patients with SS underwent serological tests such as autoantibodies, immunoglobulins, and complement. The correlation between the relevant data was compared using the t test and the rank sum test. Results:The Nelson grade ≥2 is the positive cut-off value for the diagnosis of SS. The sensitivity was 68.4%, and the specificity was 89.5%, and the area under the receiver operating characteristic curve (ROC) was 0.767. In patients with SS, there was statistical correlation between the results of conjunctival impression cytology and antinuclear antibody (ANA) ( χ2=4.664, P=0.031), anti-SSA antibody ( χ2=8.58, P<0.01), anti-SSB antibody ( χ2=6.13, P=0.013), anti-SSA-52 antibody ( χ2=6.48, P=0.011), immunoglobulin (Ig)G ( t=-4.344, P<0.01) and rheumatoid factor (RF) ( U=25.0, P<0.01). Conclusion:Con-junctival impression cytology has certain value in the diagnosis of SS and can be used to evaluate conjunctival lesions in SS. Serum ANA, anti-SSA antibody, anti-SSB antibody, anti-SSA-52 antibody, IgG, and RF levels are significantly associated with the degree of conjunctival lesions, and can be considered as an indirect evidence of conjunctival involvement in SS.
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Objective To investigate the clinical and immunological features of primary Sj(o)gren's syndrome (pSS) in both sexs,and to find out the pathophysiology of pSS.Methods Clinical data of 110 pSS cases were analyzed retrospectively,and cytokine levels of interleukin (IL)-2,IL-4,IL-6,IL-10,IL-17A,Tumour necrosis factor (TNF)-α,interferon (IFN)-α were measured (male=20,female=90) in patients and healthy controls (n=30) using enzyme linked immunosorbent assay (ELISA).Results Compared with female patients,no significant difference was found in male patientsin symptoms of dry mouth and dry eye (90.0％ vs 98.9％,x2=4.874,P＞0.05);the frequency of parotid gland enlargement and lymphadenectasis were higher in male (40.0％ vs 5.6％,x2=18.629,P＜0.01;25.0％ vs 6.7％,x3=6.111,P＜0.05);and the level of immunoglobu lin (Ig)A and C4 [2.2(1.5,3.0) g/L vs 3.3(2.5,5.0) g/L,Z=-3.119,P＜0.01;(0.15±0.05) g/L vs (0.19±0.08) g/L,t=-2.659,P＜0.05] were lower in male,as well as the incidence of positive anti SSA/SSB antibodies (55.0％ vs 78.8％,x2=4.921,P＜0.05).Cytokine levels of IL-2,IL-6,TNF-α (t=-3.783,-6.193,-2.065,P＜0.05) were higher in pSS than HC.Compared with female patients,cytokine levels of IL-10,IFN-γ (t=-1.075,6.286,P＜0.05) were higher in male,however,the levels of IL-2,TNF-o (t=-3.472,-5.867,P＜0.01) were lower in male.Conclusion There are differences in the cytokine levels secreted from Thl and Th2 cell between male and female patients of pSS,which may relate to the clinical and immunological characteristics and can help to reveal the pathophysiology of pSS.