Clinical observation of Gushen antai pill combined with heparin sodium in the treatment of anticardiolipin antibody-positive recurrent abortion / 中国药房

OBJECTIVE To investigate the clinical efficacy of Gushen antai pills combined with heparin sodium in the treatment of antiphospholipin antibody （ACA）-positive recurrent abortion. METHODS A total of 203 ACA-positive recurrent abortion patients were randomly divided into control group （n＝101） and combination treatment group （n＝102）. Control group was additionally treated with heparin sodium on basis of basic treatment， and combination treatment group was additionally treated with Gushen antai pills on the basis of control group. Serum samples were collected from patients， the levels of interleukin 6 （IL- 6）， tumor necrosis factor α （TNF-α）， cyclooxygenase 2 （COX-2）， β-human chorionic gonadotropin （β-HCG） and ACA were detected by enzyme-linked immunosorbent assay. The antibody-negative conversion rate was calculated， the clinical efficacy of the patient was observed， and the occurrence of adverse drug reactions was recorded. RESULTS After treatment， the pregnancy success rate and antibody-negative conversion rate of combination treatment group were significantly higher than those in the control group （P＜0.05）， and the abortion rate was significantly lower than that in the control group （P＜0.05）. Compared with before treatment， serum levels of IL-6， TNF-α and ACA in 2 groups were decreased significantly （P＜0.05）， while the levels of COX-2 and β-HCG were increased significantly （P＜0.05）； the changes of above indexes in combination treatment group were more significant（P＜0.05）. There was no statistical significance in the incidence of adverse drug reactions between 2 groups（P＞0.05）. CONCLUSIONS Gushen antai pills can maintain high expression of β-HCG， reduce the level of ACA and improve immune microenvironment in patients with ACA-positive recurrent abortion by increasing the serum level of COX-2 and decreasing the serum level of IL-6， so as to increase the success rate of pregnancy.

Correlations of anti-cardiolipin antibody and anti-β2 glycoprotein I antibody with ischemic stroke in patients with systemic autoimmune diseases / 中国基层医药

Objective:To correlate anti-cardiolipin antibody (aCL) and anti-β2 glycoprotein I antibody (aβ2GPI) with ischemic stroke (IS) in patients with systemic autoimmune diseases (SADs).Methods:A total of 104 patients with SADs who received treatment in the Affiliated Hospital of North Sichuan Medical College during January to December 2019 were included in this study. They were divided into two groups whether they had IS (IS group, n = 42) or not (non-IS group, n = 62). aPL positive rate was qualitatively compared between the IS and non-IS groups. aCL and aβ2GPI expression levels were quantitatively compared between the IS and non-IS groups. Logistic regression analysis was performed to evaluate the risk factors for IS in patients with SADs. Results:aPL positive rate in the IS group was significantly higher than that in the non-IS group [61.9% (26/42) vs. 40.3% (25 /62), χ2 = 4.66, P = 0.031]. The aCL-IgM and aβ2GPI-IgM levels in the IS group were (22.82 ± 27.27) RU/mL and (18.70 ± 23.95) RU/mL, respectively, which were significantly higher than those in the non-IS group [(13.34 ± 8.43) RU/mL, (7.61± 5.80) RU/mL, t = -2.18, -2.76, P = 0.034, 0.009]. Logistic regression analysis showed that aPL is an independent risk factor for IS ( P = 0.037). Conclusion:aCL and aβ2GPI are closely related to the occurrence of IS and are the independent risk factors for IS in patients with SADs.

Diagnosis and treatment of hepatic sinusoidal obstruction syndrome after liver transplantation: a single-center experience / 器官移植

Objective To summarize the incidence, diagnostic and therapeutic experience of hepatic sinusoidal obstruction syndrome (HSOS) after liver transplantation. Methods Clinical data of 4 patients with HSOS after liver transplantation were retrospectively analyzed. The incidence, clinical manifestations, imaging and pathological characteristics of HSOS after liver transplantation were collected, and the treatment methods and clinical outcomes of patients with HSOS were analyzed. Results The incidence of HSOS after liver transplantation was 0.8%(2/239), and the median time of onset was 4.5(1.7, 9.0) months after liver transplantation. The clinical manifestations of HSOS mainly included abdominal distension, ascites, hepatomegaly, increased bilirubin, and renal insufficiency in partial cases. Enhanced abdominal CT scan of 4 patients with HSOS showed uneven spot-like enhancement and the liver histopathological examination mainly showed the signs of hepatic sinusoidal dilatation complicated with congestion. Four patients were administered with an adjusted regime of immunosuppressant by replacing tacrolimus (Tac) with ciclosporin and adding anticoagulant therapy with warfarin. One patient received transjugular intrahepatic portosystemic shunt (TIPS). After treatment, the symptoms of 3 patients were completely relieved, and 1 patient died. One of the 3 surviving patients died from pulmonary infection and gastrointestinal bleeding. Conclusions HSOS is a rare and fatal complication after liver transplantation. Timely diagnosis and treatment can avoid the incidence of graft failure and improve clinical prognosis of the patients.

Anticuerpos contra la cardiolipina en glomerulonefritis postestreptocócica concurrente con anemia hemolítica autoinmunitaria: a propósito de un caso / Anticardiolipin antibodies in concurrent poststreptococcal glomerulonephritis and autoimmune hemolytic anemia: A case report

En este artículo, presentamos el caso de una paciente con glomerulonefritis aguda postestreptocócica (GNAPE) y anemia hemolítica autoinmunitaria (AHAI). Además de los signos típicos de la GNAPE, la paciente tuvo un resultado positivo en la prueba de antiglobulina directa y anticuerpos contra la cardiolipina sin que presentara las manifestaciones clínicas típicas del síndrome antifosfolipídico. Este caso genera dudas respecto de la relación entre el estreptococo y el desarrollo de anemia hemolítica autoinmunitaria en los niños. Este caso destaca la posibilidad de que las infecciones estreptocócicas de nuestra paciente podrían haber causado la anemia, ya sea en el contexto de anticuerpos antifosfolipídicos preexistentes o por haber desencadenado el desarrollo de anticuerpos patogénicos, que luego lleva a la presentación clínica de hemólisis. Se presume que, en la paciente, los anticuerpos contra la cardiolipina inducidos por la infección estreptocócica podrían tener una función directa en la presentación clínica de AHAI.

We present a case of acute post-streptococcal glomerulonephritis (APSGN) with autoimmune hemolytic anemia (AIHA). Along with the classic findings of APSGN, the patient had a positive direct antiglobulin test and an anticardiolipin antibody without any typical clinical manifestations of antiphospholipid syndrome (APS). This case raises questions of the relationship between Streptococcus and the development of autoimmune hemolytic anemia in children. Our case highlights the possibility that the streptococcal infections in this patient might be responsible for her anemia, either in setting of underlying antiphospholipid antibodies, or in having triggered the development of pathogenic antibodies, which subsequently leads to the clinical evolution of hemolysis. It is presumed that in our case, the anticardiolipin antibody induced by streptococcal infection may play a direct role in the clinical evolution of AIHA.

Sudden sensorineural hearing loss: A missed opportunity for treatment

@#Sudden sensorineural hearing loss (SSNHL) is an otology emergency and carries significant morbidity if the diagnosis is missed. It can present to any specialty but in our local setting the patient usually presents to primary care as it is easily accessible. We present a case of SSNHL that was initially presented to a primary care centre and the patient was reassured without any investigation being carried out. SSNHL has many causes thus making diagnosis difficult. However, with knowledge of its possible, a diagnosis can be made and appropriate management can be advocated to the patient. Hence, we discuss the three main causes of SSNHL, while emphasizing the immune system-mediated mechanism as the main cause in this case.

The relationship between the serum ACA, VEGF concentration and cognitive impairment in patients with cerebral infarction / 中华行为医学与脑科学杂志

Objective To explore the relationship between the serum anticardiolipin antibody (ACA),vascular endothelial grow factor (VEGF) concentration and cognitive impairment in patients with ischemic stroke.Methods Totally 128 cases with acute ischemic stroke were admmitted in stroke unit ward of our hospital during June 2014 to December 2014.According to the score of Montreal cognitive assessnent (MoCA),128 patients with ischemic stroke were divided into groups A (53 cases with cognitive impairment) and group B (75 cases without cognitive impairment).The concentrations of serum ACA,VEGF were quantitatively determinated by ELISA.The differences of serum ACA,VEGF concentrations were compared between the two groups.Results Compared with normal cognitive function group,the cognitive impairment patients had significantly higher ACA concentration ((0.86±0.16) mg/L vs (0.52±0.08) mg/L,P＜0.01),and lower VEGF concentration ((197.60±7.48) pg/ml vs (205.80±8.52) pg/ml,P＜0.05).Logistic regression revealed that ACA and VEGF were independent effect factors for cognitive impairment (ACA:B =2.841,OR =0.33,95 ％ CI =0.118-0.926,P=0.025.V EGF:B =-1.674,OR =4.99,95％ CI =1.688-4.741,P=0.034).Conclusion ACA and VEGF may play an important role in cognitive impairment after ischemic stroke.

Associations of anticardiolipin antibody with systemic lupus erythematosus and lupus nephritis in children / 临床儿科杂志

ObjectiveTo evaluate the role of serum IgM, IgG and IgA anticardiolipin antibody (ACA) isotypes in the diagnosis of systemic lupus erythematosus (SLE), and their association with lupus nephritis (LN) in children.Methods One hundred and sixteen hospitalized SLE pediatric patients were selected between April 2005 and October 2013. The clinical data were collected and analyzed.Results There were 20 males and 96 females among 116 SLE patients. The positive rate of ACA-IgG, ACA-IgM and ACA-IgA was 37.1%, 35.3%, 26.7% respectively, without signiifcant difference between each other (P>0.05). Among 116 SLE patients, 75 cases had LN and 41 cases had no LN. The positive rates of ACA-IgM and ACA-IgA were not sig-niifcantly different between cases with and without LN (P>0.05). Cases with LN (42.7%) had higher ACA-IgG positive rate than cases without LN (22.0%) (P=0.026). The occurrence of LN and the positive rate of ACA isotypes were not signiifcantly different between genders (P>0.05).Conclusions The different isotypes of ACA have the same signiifcance in the diagnosis of SLE. The detection of ACA-IgG helps diagnose the LN complicated with SLE.

Anticardiolipin antibody-immune globulin G,interleukin-10/17 and intracranial large-artery atherosclerotic stenosis:a correlation study / 中国脑血管病杂志

Objective To investigate the relationship between serum anticardiolipin antibody-immune globulin G (ACA-IgG),interleukin-10 (IL-10 ),IL-17 levels and intracranial large-artery atherosclerotic stenosis in patients with ischemic stroke. Methods From March 2014 to March 2015,a total of 176 consecutive patients with the first-ever ischemic stroke admitted to the Department of Neurology,Liaocheng People′s Hospital,Shandong Province,China,and performed DSA were enrolled prospectively. Seven of the patients with cardiogenic embolism,5 with moyamoya disease,8 with arteritis,2 with artery dissection,9 with autoimmune diseases or acute and chronic inflammation were excluded,21 with extracranial arterial stenosis were not enrolled,and finally 124 were enrolled in the study. According to the findings of DSA,the degrees of intracranial large artery stenosis were divided into a stenosis-free group (n = 34),a mild-stenosis group (n = 30),a moderate-stenosis group (n = 32),and a severe-stenosis group (n = 28). The differences of serum ACA-IgG,IL-10,IL-17 levels and baseline factors of the 4 groups were compared,and multivariate logistic regression analysis was used to analyze several factors that affected intracranial large-artery stenosis. Results There were no significant differences in sex,age,alcohol consumption rate,smoking rate,and incidence of hyperlipidemia among the 4 groups of patients (all P >0. 05). Compared with the stenosis-free group,there were significant differences in the incidences of hypertension and diabetes among the mild-stenosis,moderate-stenosis and severe-stenosis groups (the incidence of hypertension,80. 0% [n = 24],93. 8% [n = 30],89. 3% [n = 25]vs. 55. 9% [19 cases];χ2 = 8. 271,8. 920,and 10. 877,respectively;P = 0. 038,0. 032,and 0. 014,respectively). The incidences of diabetes were 33. 3% (n = 10),43. 8% (n = 14),60. 7% (n = 17)vs. 8. 8% (n = 3),(χ2 = 7. 960, 8. 733,and 9. 285,respectively;P = 0. 043,0. 035,and 0. 027,respectively). Incidence of diabetes of the severe-stenosis group was higher than that of the mild-stenosis group (χ2 = 9. 348,P = 0. 025). There were no significant differences in the incidences of hypertension and diabetes among other groups (all P >0. 05). There were significant differences in ACA-IgG levels (23 ± 5,39 ± 8,51 ± 9,and 65 ± 10 kU/ L);IL-10 levels (108 ± 33,85 ± 25,77 ± 21,and 62 ± 19 ng/ L),and IL-17 levels (38 ± 10,58 ± 22,63 ± 31, and 75 ± 26 ng/ L)among the stenosis-free,mild,moderate and severe-stenosis groups (F = 17. 754,9. 827, and 12. 656;respectively;all P 0. 05). The results of logistic regression analysis showed that hypertension, diabetes,ACA-IgG level,and IL-17 level were the risk factors for intracranial large-artery stenosis (OR, 3. 043,95% CI 1. 606 -5. 875,P = 0. 003;OR,2. 912,95% CI 1. 513 -5. 824,P < 0. 01;OR,1. 837,95% CI 2. 057-3. 416,P = 0. 037;OR,1. 453,95% CI 1. 346 -2. 721,P = 0. 014). Conclusion ACA-IgG and IL-17 may play an important role in the occurrence and development processes of intracranial large-artery atherosclerotic stenosis.

Serum high sensitive c-reactive protein and anticardiolipin antibody level in cad patients with and without type 2 diabetes mellitus.

The increased incidence of coronary artery disease (CAD) in Type 2 Diabetes mellitus is not fully explained by the conventional risk factors. Our aim was to determine the association of biomarkers, high sensitive CRP and anticardiolipin antibody (acL) with severity of coronary artery disease in patients with and without type 2 DM. In our study, hsCRP level was significantly high in CAD with DM and found to be positively correlated with severity (p<0.01) while anticardiolipin antibody does not show any significant change among the two groups. Our study concluded that increased risk of CAD in type 2 DM patients is not only because of dyslipidemia but inflammatory events also play a major role. hsCRP was found to be a valuable predictor for CAD in type 2 DM.

Study of anticardiolipin antibody in hepatitis C virus-positive patients

Several antibodies, including anticardiolipin antibodies (ACA), have been detected among chronically infected hepatitis C virus (HCV) patients. The present work aimed at ascertaining the clinical significance of ACA levels among HCV infection associated with two commonly encountered diseases, thrombocytopenia and arteriovenous-shunt malfunction. Six groups were studied, 11 HCV-positive thrombocytopenic patients (group I), 14 HCV-positive non-thrombocytopenic patients (group II) and 15 healthy controls (group III), 11 anti-HCV-positive hemodialysis patients with non-functioning shunt (group IV), 14 anti-HCV-positive hemodialysis patients with patent shunt (group V) (Bain Medical Equipment Co., China) and 15 healthy controls (group VI). Anticardiolipin antibody (ACA) assay was performed on all patients and controls whereas tumor necrosis factor α (TNF-α) assay was carried out on thrombocytopenic patients and controls. Thrombocytopenic groups presented an inverse correlation between IgG ACA levels and both thrombocytopenia and TNF-α levels. During the follow-up period, no other clinical manifestations related to ACA were developed. Hemodialysis groups showed a significant elevation in IgG ACA levels in groups IV and V compared to the controls, with statistically higher levels in group IV than group V. Three group IV patients were hypercholesterolemic. We can conclude that induction of proinflammatory cytokines such as TNF-α by persistent HCV infection may promote the generation of ACA. Complications of HCV, including thrombocytopenia and thrombosis in arteriovenous shunt, are more strongly correlated with IgG ACA than with IgM ACA.(AU)

Clinical characteristics of 39 patients with systemic lupus erythematosus and antiphospholipid syndrome / 中国综合临床

Objective To understand the clinical characteristics of systemic lupus erythematosus with Antiphospholipid syndrome (SLE-APS).Methods The clinical data of 39 cases of SLE-APS were collected and analyzed retrospectively. Results Thirty-one patients had 48 thrombosis episodes in total, among which the most common presenting manifestations were deep venous thrombosis and stroke. 12 of 26 married women had fetal morbidity. The prevalence of anticardio lipin antibody (aCL) and lupus anticoagulant ( LA) was 72% and 41% , respectively. 24 patients had SLE at first,on an average of 9. 5 years later they had the characteristics of APS, 12 patients had thrombosis episodes or fetal morbidities ,4. 8 years later they developed into SLE,and 3 patients had the characteristics of SLE and APS from the onset The SLEDAI was less than 5 in five cases when they had thrombosis episodes or fetal morbidities.Conclusions The incidence of thrombosis episodes or fetal morbidities increased in SLE-APS patients. APS occurred before, after or at the same time with SLE. SLE patients might have the clinical features of APS during the steady stage. It's very important to ask the medical history in detail and measure aCL in lupus patients to find the risk factor of APS and prevent the APS' occurrence.

The association of anticardiolipin antibody and protein C with portal vein thrombosis / 中华消化杂志

Objective To investigate the changes of anticardiolipin antibody(ACA) and protein C(PC) in cirrhotic patients with or without portal vein thrombosis(PVT). Methods During Jan. 2006 to Dec. 2007, 60 cirrhotic patients with (n=20) or without (n=40) PVT were analyzed. The concentrations of prothrombin time (PT), activited patial thromboplastin time (APTT), fibrogen, ACA and protein C (PC) were determined. Results The positive rate of ACA was 35% (7/20) in PVT group and 10% (4/40) in control group (P=0.045). The average level of ACA-IgG was significantly higher in PVT group [(10.15±5.31)U/ml] than that in control group [(6.70±3.75) U/ml]. The concentration of PC was significantly lower in PVT group [(2.47±0.62) mg/L] than that in control group [(2.93±0.88)mg/L]. No difference was found in APTT, levels of fibrogen and ACA-IgM between two groups. PT and APTT were progressively prolonged and fibrogen and PC were decreasing with the severity of Child-Pugh, respectively. The levels of ACA-IgG and ACA-IgM were increasing with the severity of Child-Pugh. Conclusions The coagulation and anticoagulation system is abnormal in patients with PVT who has higer ACA-IgG level and lower PC level. It is indicated that the ACA and PC may play an important role in formation of PVT.

The correlation of antiphospholipid antibody and factor Ⅻ deficiency in patients with retinal vein occlusion / 眼科研究

Objective Antiphospholipid antibody and factor Ⅻ deficiency are among the coagulation disorders that have been implicated in many thrombembolic events. The aim of this study was to investigate the prevalence of antiphospholipid antibodies and factor Ⅻ deficiency in patients with retinal vein occlusion (RVO). Methods The investigation was a case control study. The periphery blood was collected from a cohort of 33 consecutive patients with RVO and 30 age- and gender-matched normal subjects. Anticardiolipin antibody (ACA) was detected by ELISA as binding index (BI) =A value/standard A value. The lupus anticoagulant antibody was examined by APTT test and the activity of factor Ⅻ was detected. This study was approved by The Human Research Ethics Committee of this hospital, and written informed consent was obtained from all the subjects before initiation of any study protocol. Results The total positive rate of APA in RVO group was 24. 24% (8/33), showing a insignificant difference in comparison with control group (6. 67%, 2/30) (P = 0. 085). The positive rate of anticardiolipin antibody in RVO group was 18.18% (6/33), presenting an obvious enhance in control group (P = 0. 025) . Three patients in RVO group disclosed positive response for IgG-anticardiolipin antibody, one patient for IgM-anticardiolipin antibody, two patients for both isotypes IgG and IgM anticardiolipin antibodies, and two patients revealed positive reaction for lupus anticoagulant antibody. The presence of lupus anticoagulant antibody among the patients with ≤ 50 years and ＞ 50 years was similar to that in age-matched controls (P =0. 160, P =0. 206). Factor Ⅻ deficiency was found in 14 of 33 patients(42. 42%) and in 4 of 30 controls(13. 33%) (P = 0. 013). The prevalence of factor Ⅻ deficiency among the patients with ≤50 years and ＞ 50 years was similar to that in age-matched controls (P = 0. 206, P = 0. 052) . Conclusion Our results indicate that the prevalence of ACA and factor Ⅻ deficiency in RVO patients appears to be correlated.

Bilateral Central Retinal Vein Occlusion in Primary Antiphospholipid Syndrome

PURPOSE: To Report a case of bilateral central retinal vein occlusion (CRVO) caused by primary antiphospholipid syndrome. METHODS: A 38-year-old male is referred to the department of ophthalmology for the bilateral visual loss. RESULTS: On initial visit, both visual acuity was 0.3. Upon consider changing to fundoscopic examination, the patient was diagnosed with bilateral CRVO. We performed hematologic tests including thrombophilia examination. There were no abnormal findings on routine hematologic tests. Antinuclear antibody and rheumatoid factor were negative but anticardiolipin antibodies presented high titer, on two occasions six weeks apart. We prescribed oral aspirin and performed intravitreal bevacizumab injection under the diagnosis of bilateral CRVO in primary antiphospholipid syndrome. CONCLUSIONS: It may be necessary to check antiphospolipid antibody in cases of bilateral CRVO in young patients without medical problem.

The relationship between anticardiolipin antibody and elderly patients with essential hypertension and the therape of valsarta / 中国实用内科杂志

Objective To study anticardiolipin antibody(ACLA)in elderly patients with essential hypertension(EH)and to investigate the influence of valsarta on the function of vascular endothelium.Methods The levels of ACLA were measured by an enzyme-linked immunoabsorbent assay in 120 patients with EH and 30 healthy controls.All parameters were compared in the EH patients with different stratification.Sixty elderly hypertension patients were treated with valsarta for 6 weeks of with the dose range from 80 to 160 mg/d and compared with 60 healthy elderly people before and after treatment by measuring the levels of ACLA.Results The concentration of ACLA were significantly higher in patients with risk,higher risk and very high risk group than those in healthy control group and patients with low risk group(P0.05).After 6 weeks of treatment with valsarta,systolic and diastolic pressures remarkably decreased and the levels of ACLA were decreased significantly;the higher the degree,the more notable the change of ACLA.Conclusion The patients with EH might have self-immunity.The results suggest that circulating ACLA might have clinical significance in forecasting the severity of EH.Valsarta is effective in treating hypertension,which may improve the function of vascular endothelium.

Enfermedad cerebrovascular y trombosis de miembros superiores como manifestación de síndrome antifosfolipídico primario, presentación de caso / Cerebrovascular Disease and thrombosis of superior members as manifestation of antifosfolipidic syndrome, case presentation

El síndrome antifosfolípido es una afección multisistémica con trombosis arteriales y/o venosos, trombocitopenia más pérdida fetal que puede ser primaria o secundaria a enfermedades subyacentes.Presentamos el caso de una mujer de 44 años de edad, que ingresó por deterioro del sensorio, cianosis distal de extremidades superiores, sin que se palpe pulsos periféricos ni se ausculte presión arterial, mientras que en extremidades inferiores hay presencia de pulsos periféricos y auscultación de presión arterial. Reporta como antecedente el que hace un mes presentó enfermedad cerebro vascular.Examen de laboratorio:Antifosfolípido Ig M 1,5 UI/mlAnticoagulante lúpico: PositivoAnticardiolipina: Resultado IgG: 12,46 IgM: 9.56

The antiphospholipidic syndrome is an multisystemic affliction with arterial and venal thrombosis, thrombocytopenia and fetal loss that can be primary or secondary to underlying illnesses. We present a case of a 44 year-old woman that was admitted due to for deterioration of the deterioration of sensory functions, cyanosis of distal superior extremities, with the absence of distal pulses and arterial pressure, while in inferior extremities there are presence of pulses and arterial pressure. Clinical background of having suffered cerebrovascular accident a month before.Laboratory exam:Antifosfolipid Ig M 1,5 UI/mlLupus Anticoagulant: PositiveAnticardiolipin: ResultIgG: 12,46 IgM: 9.56

Antiphospholipid syndrome: clinical and immunologic manifestation and patterns of disease expression in a cohort of 100 patients / 中华风湿病学杂志

Objective To analyze the clinical and immunological manifestations of antiphospholipid syndrome(APS)in a cohort of 100 patients.Methods The clinical and serologic features of APS(Sapporo preliminary criteria)in 100 patients were analyzed retrospectively.Results The cohort consisted of 79 female patients and 21 male patients witb a mean age of 36?13 years at diagnosis.Primary APS was presented in 37% of patients;APS was secondary to systemic lupus erythematosus(SLE)in 46%,lupus-like syndrome in 14%. Eighty percent of the patients had thrombosis,43(54%)patients had venous thrombosis,18(22%)had arterial thrombosis,15(19%)had both arterial and venous thrombosis.4(5%)had thrombosis of microcirculation. Forty-two(52%)patients presented thrombosis at a single site,26(32%)at two sites,12(15%)at three or more sites.Forty-five(56%)patients experienced one thrombotic episode,20(25%)patients had only one re- currence,and 15(19%)had more thrombosis.The most common manifestations of thrombosis were deep vein thrombosis(36%),pulmonary embolism(30%)and stroke(26%),with heart,kidney,gastrointestinal tract and other organs involvements.Thirty-four(51%)female patients had spontaneous fetal losses including intrauter- ine fetus death and recurrent spontaneous abortion.Seventy-one(71%)patients developed thromboeytopenia. The presence of antieardiolipin antibody(ACL)was detected in 84 patients(84%).Among 90 patients with APS,alone ACL was detected in 38 patients(42%),both ACL and lupus anticoagulant(LA)were detected in 36(40%),LA alone in 16(18%).Patients with APS associated with SLE or lupus-like syndrome had higher frequency of arthritis,leukopenia,antinuclear antibodies(ANA)and low complement levels.Female patients had a higher frequency of leukopenia,ANA and ACL.Male patients had a higher prevalence of deep venous thrombosis in the lower limbs and LA.Conclusion APS is an autoimmune disorder characterized by recurrent arterial and venous thrombosis,fetal loss,or thrombocytopenia with the presence of ACL and/or LA.In APS secondary to with SLE,the patient's sex can modify the disease expression and define specific subsets of APS.

Predictive Factors for Seizure Attack in Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: This study was designed to identify the risk factors associated with seizure attack in patients with systemic lupus erythematosus (SLE) and to propose the usefulness of them as predictive factors for seizure attack. METHODS: One hundred patients with SLE were included in this study. Twenty-five of these patients had seizure attacks during the course of their disease and age-, sex-matched 75 patients who did not have seizure were control group. We compared clinical manifestations and laboratory findings between the two groups. Seizures not related to SLE were excluded. RESULTS: Risk factors associated with seizure attack in SLE were high damage index at initial presentation and the presence of anticardiolipin antibody IgG regardless of its titer. Underlying illness other than SLE, duration of SLE, presence of previous organic brain abnormality, SLEDAI at initial presentation, clinical manifestations of SLE, laboratory findings (including hematologic, immunologic parameters and known laboratory activity indices) and medications before seizure attack were not significantly associated with seizure attack. Recurred seizure was not associated with any of these factors. CONCLUSION: High damage index at initial presentation and the presence of anticardiolipin antibody IgG were associated with seizure attacks in patients with SLE. These factors may be used as predictive factor for seizure attack in SLE.

The Association of HLA-DRB1 and DQB1 Alleles and a Study of Anticardiolipin Antibody and Anti-beta2 Glycoprotein I Antibody in Korean SLE Patients

BACKGROUND: Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized by diverse clinical manifestations and autoantibody production, which is known to be strongly influenced by genetic factors. Previous studies have revealed the associations of SLE with HLA class II alleles and antiphospholipid antibody system (anticardiolipin antibody (aCL) and anti-beta2 glycoprotein I antibody (anti-beta2 GPI)). Therefore, we studied the associations of HLA class II alleles with SLE and antiphospholipid antibody system. METHODS: The genotyping for HLA-DRB1 and DQB1 alleles were performed in 61 SLE patients and 100 controls by the polymerase chain reaction (PCR)-sequence specific oligonucleotide probe method. ELISA tests for aCL and anti-beta2 GPI were performed in 39 of the 61 SLE patients. The results were evaluated statistically by Chi-square test. RESULTS: The frequencies of the HLA-DRB1*15 and DQB1*06 in SLE patients were significantly higher than those in controls. HLA-DRB1*12 was significantly lower in SLE patients than controls. Nine of 39 patients were positive for aCL (IgG) and three were positive for aCL (IgM). One of 39 patients were positive for anti-beta2 GPI (IgG) and none of them positive for anti-beta2 GPI (IgM). Association of aCL with HLA class II alleles was not observed in our study. CONCLUSION: According to our results, it was found that HLA-DRB1*15 and DQB1*06 were associated with genetic susceptiblility and DRB1*12 was associated with resistance to SLE in Korean population. No Association of aCL with HLA class II alleles was observed and the positive rate for anti-beta2 GPI was very low.

A Case of a Budd-Chiari Syndrome Associated with a Large Atrial Thrombus in Antithrombin Deficiency and Antiphospholipid Syndrome / 대한혈액학회지

Antiphospholipid antibody is associated with a clinical syndrome of vascular thrombosis, thrombocytopenia, recurrent fetal loss and cerebrovascular accident whether or not the clinical diagnosis of SLE coexists. Antithrombin deficiency leads to thromboembolism in the venous system. It develops an asymptomatic venous occlusion in many cases, but when it develops cerebral venous thrombosis, mesenteric venous thrombosis or Budd-Chiari syndrome, it leads to special clinical problems. We report the finding of a low anti-thrombin level and IgM anticardiolipin antibody in a patient who has had episodes of a large thrombus in the right atrium and Budd-Chiari syndrome due to the thrombus.