[Clinical characteristics and diagnostic indicators of macrophage activation syndrome in patients with systemic lupus erythematosus and adult-onset Still's disease].

OBJECTIVE: To analyze and compare the clinical and laboratory characteristics of macrophage activation syndrome (MAS) in patients with systemic lupus erythematosus (SLE) and adult-onset Still's disease (AOSD), and to evaluate the applicability of the 2016 European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organization classification criteria for MAS complicating systemic juvenile idiopathic arthritis (sJIA) in different auto-immune diseases contexts and to propose new diagnostic predictive indicators. METHODS: A retrospective analysis was conducted on the clinical and laboratory data of 24 SLE patients with MAS (SLE-MAS) and 24 AOSD patients with MAS (AOSD-MAS) who were hospitalized at Peking University People's Hospital between 2000 and 2018. Age- and sex-matched SLE (50 patients) and AOSD (50 patients) diagnosed in the same period without MAS episodes were selected as controls. The cutoff values for laboratory indicators predicting SLE-MAS and AOSD-MAS were determined using receiver operating characteristic (ROC) curves. Furthermore, the laboratory diagnostic predictive values for AOSD-MAS were used to improve the classification criteria for systemic juvenile idiopathic arthritis-associated MAS (sJIA-MAS), and the applicability of the revised criteria for AOSD-MAS was explored. RESULTS: Approximately 60% of SLE-MAS and 40% of AOSD-MAS occurred within three months after the diagnosis of the underlying diseases. The most frequent clinical feature was fever. In addition to the indicators mentioned in the diagnosis criteria for hemophagocytic syndrome revised by the International Society for Stem Cell Research, the MAS patients also exhibited significantly elevated levels of aspartate aminotransferase and lactate dehydrogenase, along with a significant decrease in albumin. Hemophagocytosis was observed in only about half of the MAS patients. ROC curve analysis demonstrated that the optimal discriminative values for diagnosing MAS was achieved when SLE patients had ferritin level≥1 010 µg/L and lactate dehydroge-nase levels≥359 U/L, while AOSD patients had fibrinogen levels≤225.5 mg/dL and triglyceride levels≥2.0 mmol/L. Applying the 2016 sJIA-MAS classification criteria to AOSD-MAS yielded a diagnostic sensitivity of 100% and specificity of 62%. By replacing the less specific markers ferritin and fibrinogen in the 2016 sJIA-MAS classification criteria with new cutoff values, the revised criteria for classifying AOSD-MAS had a notable increased specificity of 86%. CONCLUSION: Secondary MAS commonly occurs in the early stages following the diagnosis of SLE and AOSD. There are notable variations in laboratory indicators among different underlying diseases, which may lead to misdiagnosis or missed diagnosis when using uniform classification criteria for MAS. The 2016 sJIA-MAS classification criteria exhibit high sensitivity but low specificity in diagnosing AOSD-MAS. Modification of the criteria can enhance its specificity.

[Diagnostic significance of serum allergen detection in diagnosis of allergic rhinitis and bronchial asthma].

OBJECTIVE: To analyze the diagnostic significance of serum total IgE, specific IgE (SIgE), Phadiatop, and eosinophil cationic protein (ECP) in allergic rhinitis and bronchial asthma. METHODS: The serum total IgE, SIgE , and Phadiatop were tested in 122 patients with allergic rhinitis. The ECP, SIgE, and Phadiatop were tested in 135 patients with bronchial asthma. Forty healthy persons were used as controls. The serum total IgE were tested by electrochemiluminescence. The serum Phadiatop, ECP, and SIgE were tested by fluorescent-enzyme linked immunosorbent assay. RESULTS: The serum total IgE positive rate of the 122 allergic rhinitis patients was 37.7%, significantly higher than that of the healthy controls (2.5%, chi2 = 18.13, P < 0.01). The specificity of total IgE of the allergic rhinitis patients were 97.5%. The serum ECP positive rate of the bronchial asthma patients was 65.9%, significantly higher than that of the healthy controls (20.0%, chi2 = 26.34, P < 0.01). The sensitivity and specificity of the bronchial asthma patients were 65.9% and 80.0%. The Phadiatop positive rates of the allergic rhinitis and the bronchial asthma patients were 50.0% and 31.9% respectively, both significantly higher than that of the control (0, chi2 = 32.08, 16.89, both P < 0.01). Most kinds of SIgE were from the allergens, such as dust mite, dust, and Artemisia etc. CONCLUSION: Increase of serum ECP level is an important indicator of airway inflammation activity and inflammation serious degree in the bronchial asthma patients. The increase of serum total IgE has an important diagnostic significance in allergic rhinitis. It is important to detect SIgE and Phadiatop in diagnosis and monitoring of allergic rhinitis and bronchial asthma.