[Studies of serum markers in patients with interstitial pneumonia/pulmonary fibrosis complicated with collagen diseases: clinical evaluation of CYFRA21-1].

The serum concentration of several markers in patients with collagen disease was studied to evaluate the useful indices for the diagnosis of interstitial pneumonia/pulmonary fibroses (pneumonitis). Procollagen N-terminal type III peptides, type IV collagen and monoamine oxidase were measured as the fibrosing markers. Squamous cell related antigen (SCC) and soluble cytokeratin 19 fragments (CYFRA21-1) were measured as the tumor markers. Hyaluronic acid, ESR and CRP were measured as the inflammation markers. The 119 patients with collagen disease (71 patients with RA, 16 with SSc, 9 with SLE, 8 with PM/DM, 6 with MCTI) and 9 with other collagen diseases) who have been followed in our hospital were studied. Of 119 patients, 23 patients (RA14, SSc7, PM/DM2) were complicated with pneumonitis. The results were as follows. 1. All the serum markers except CYFRA21-1 had no significantly difference between with and without pneumonitis. The serum CYFRA21-1 level in the pneumonitis group was higher than that of the non pneumonitis group (1.38 vs 0.66 ng/ml, P < 0.001). 2. The cut-off value was set at 2.0 ng/ml, corresponding to 26.1% sensitivity and 97.9% specificity for pneumonitis complicated with collagen disease. 3. The CYFRA21-1 level in early stage of pneumonitis group (from onset to measurement < 1 year) was significantly higher than that of late stage group (from onset to measurement > 1 year). And there are 75.0% sensitivity in early stage of pneumonitis group. 4. Case study was suggested that CYFRA21-1 had a potential as a diagnostic and monitoring marker for pneumonitis.

[Liver disease in systemic lupus erythematosus].

Liver disease in 193 patients (17 male and 176 female) with systemic lupus erythematosus (SLE) at Kawasaki Municipal Hospital were analyzed. Abnormal transaminase levels were found in 78 case (40.4%). Among them, there were 35 patients whose liver disease were identified. There were 12 patients whom no cause could be found other than SLE. Other liver disease were as follows: fatty liver in 9 cases, virus infection in 5 cases, gall stone and/or cholecystitis in 3 cases, drug allergy in 2 cases, autoimmune hepatitis 2 cases, primary biliary cirrhoses in 1 case. Liver disease with systemic lupus erythematosus was frequent, but there was no severe case.

[Causes of death in 140 patients with rheumatoid arthritis].

The causes of death in 140 patients (30 male and 110 female) with rheumatoid arthritis (RA) at Kawasaki Municipal Hospital are analyzed. Autopsies were performed in 58%. The causes of death were infection (25.7%), heart disease (20.0%), renal failure (10.7%), cerebrovascular disease (10.0%), and respiratory failure (8.5%). The causes of death in RA patients were compared with those of 243 non-rheumatoid patients. Infection, congestive heart failure, renal failure and respiratory failure were more common causes of death in RA than in the control group. It should be noted that neoplasms are infrequent causes of death in patients with RA. The survival time (onset to death) of RA patients appears to be increasing year by year.