ABSTRACT
Objective:This study mainly discussed the clinical characteristics, autoimmune status and lymphocyte subsets of patients with Takayasu arteritis (TA) without hormone and immunosuppressive therapy, in order to provide guidance for immunotherapy.Methods:Using cross-sectional study, twenty-nine patients with TA admitted to the Department of Rheumatology and the Department of Vasculitis of Beijing Anzhen Hospital from January 2018 to November 2019 were selected, including 28 females and 1 male, with the middle age of 39 year. These patients met the diagnostic criteria of American Society of Rheumatology for TA, and were not treated with hormone and immunosuppressant. Clinical data of these patients were collected, and the immunological indexes and lymphocyte subsets of peripheral blood were detected simultaneously. At the same time, the immunological indexes and peripheral blood lymphocyte subsets of 21 healthy normal people were detected as control. Chi square test, independent sample t test and nonparametric test were used for analysis. Results:Among the 29 patients with TA, 28 were female, 26 were in the active stage of disease; the main manifestations of systemic symptoms were malaise (62.07%) and headache (41.38%), the main manifestations of vascular symptoms were bruits and pulse weakening (68.97%), and the most of Numano type was V type (79.31%). The absolute value of total T (CD3) lymphocytes [(1 337.14±312.46)μl vs (1 139.95±340.96)μl, t=2.120, P=0.039], the percentage [46.29%±6.55% vs 36.55%±7.42%, t=4.903, P<0.000 1] and the absolute value [(815.52±194.11)μl vs (571.44±187.55)μl, t=4.450, P<0.000 1] of helper T (CD4) lymphocytes, the ratio of CD4/CD8 [1.83 (1.41-2.30) vs 1.32 (1.03-1.39), Z=3.401, P=0.001] were higher compared with those of healthy controls, while the percentage of natural killer (NK) cells (CD56) [10.71%(6.45%-14.30%) vs 14.57%(10.87%-18.47%), Z=2.408, P=0.016] decreased. The complement C3 [1.16 (1.02-1.31) g/L vs 1.05 (0.93-1.15) g/L, Z=2.383, P=0.021] in patients with TA was higher than those in healthy controls and immunoglobulin (Ig) G [11.97 (8.74-14.43) g/L vs 14.37 (13.11-15.47) g/L, Z=3.017, P=0.003] in patients with TA was lower than those in healthy controls. Compared with the control group, the ESR [19.31 (9.50-28.50) mm/h vs 3.71 (2.00-5.00) mm/h, Z=5.338, P<0.000 1], hs-CRP [6.52 (0.32-8.62) mg/L vs 0.73 (0.35-1.07) mg/L, Z=2.983, P=0.003] and Q-CRP [8.73 (1.03-7.72) mg/L vs 0.57 (0.08-0.98) mg/L, Z=4.263, P<0.000 1] of patients with TA were all increased. Conclusions:The autoimmunity of patients with TA without hormone or immunosuppressant treatment is in active state, and the total T-lymphocytes and helper T-lymphocytes in peripheral blood are significantly increased in order to cope with the inflammatory response of the systemic artery vessels.
ABSTRACT
Objective To investigate the risk factors of lymph node metastasis (LNM) in patients with superficial esophageal cancer (SEC) and to evaluate its clinical application.Methods From January 2010 to December 2016,769 SEC patients,who received surgery in the First Affiliated Hospital of Nanjing Medical University,were enrolled,and their clinical data were retrospectively analyzed.Chisquare test and logistic regression analysis were performed for statistical analysis.The sensitivity,specificity,and overall positive accuracy of pathological type and depth of invasion before operation were evaluated.Results The rate of LNM in patients with SEC was 15.34％ (118/769).There were significant differences in alcohol consumption,maximum tumor diameter,histological type,differentiation degree,depth of invasion and vascular invasion between patients with LNM (118 cases) and patients withoutLNM (651 cases) (x2=5.66,13.71,40.65,20.04,36.70 and 61.51;all P＜0.05).The results of multivariate analysis showed that maximum tumor diameter＞2 cm(odd ratio (OR) 1.76,95％ confidence interval (CI) 1.12 to 2.77),poor differentiation(OR 1.92,95％CI 1.23 to 3.01),submucosal invasion(OR 2.67,95％CI 1.28 to 5.56) and vascular invasion (OR 5.28,95％CI 2.75 to 10.13) were independent risk factors of LNM in patients with SEC.The tumor location was significantly correlated with the site of LNM (x2=107.05,P＜0.01).The sensitivity and specificity of preoperative assessment of LNM were 58 ％ (51/88) and 59 ％ (301/510),respectively.The overall positive accuracy of histological type before operation was 66.7％ (440/660).The overall positive accuracy of depth of invasion evaluated by endoscopic ultrasound before operation was 27.9％ (19/68).Conclusion Endoscopic treatment is recommended for SEC patients with maximum tumor diameter ≤ 2 cm,high ormoderate degree of differentiation,tumor confined to the mucosal layer and without vascular metastasis for the relatively low risk of LNM.