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2.
Zhonghua Nei Ke Za Zhi ; 60(9): 812-816, 2021 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-34445817

RESUMO

Objective: To study clinical characteristics and pregnancy outcomes under anti-coagulation therapy of non-criteria obstetric antiphospholipid syndrome. Methods: Patients suspected of obstetric antiphospholipid syndrome(OAPS) were recruited through Chinese Rheumatism Data Center from 2015 to 2019 consecutively. Patients fulfilling 2006 Sydney revised antiphospholipid syndrome criteria were classified as OAPS. Patients fulfilling definition of non-criteria OAPS(NCOAPS) by expert consensus on diagnosis and management of obstetric antiphospholipid syndrome of China were classified as NCOAPS. Clinical characteristics and laboratory results of two groups were compared. Live birth rates and pregnancy outcomes under anti-coagulation therapy were studied. Results: A total of 88 patients were enrolled, including 56 patients (63.6%) as OAPS, 32(36.4%) as NCOAPS. Live births were only reached in 16.1% (9/56) in OAPS patients and 12.5%(4/32) in NCOAPS. Fetal losses after 10 weeks of gestation and pre-eclampsia before 34 weeks were more common in OAPS group compared to NCOAPS group [78.6%(44/56) vs. 18.8%(6/32), P<0.001; 25.0%(14/56) vs. 3.1%(1/32), P=0.020, respectively]. After enrollment, 15 pregnancies were recorded in OAPS, 10 in NCOAPS, all of whom were treated with low-dose aspirin (LDA) combined with low-molecular weight heparin (LMWH). Live birth rates saw dramatic improvements compared to baseline levels in OAPS [16.1% (9/56) vs. 11/15] along with NCOAPS [12.5% (4/32) vs. 7/10]. Conclusion: Though NCOAPS and OAPS patients differ in antiphospholipid antibody spectrum and pattern of pregnancy morbidities, both groups benefit from LDA combined with LWMH treatment, as live birth rates improve. Non-criteria OAPS patients are recommended to receive anti-coagulation therapy during pregnancy.


Assuntos
Síndrome Antifosfolipídica , Complicações na Gravidez , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/epidemiologia , Feminino , Heparina de Baixo Peso Molecular , Humanos , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Estudos Retrospectivos
3.
Zhonghua Nei Ke Za Zhi ; 60(8): 744-750, 2021 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-34304451

RESUMO

Objective: To investigate the clinical characteristics and risk factors for osteonecrosis (ON) in patients with systemic lupus erythematosus (SLE). Methods: This is a case-control study. A total of 118 patients diagnosed with SLE complicated with ON (study group) were retrospectively analyzed between 2014 and 2019. Gender, age, and course matched 118 SLE patients without ON were selected as controls. Clinical manifestations, laboratory findings, medical history, and treatments were recorded and analyzed. Results: Among 118 patients, the male to female ratio was 20 to 98 with a median age of 27 years and course of disease 1-168 months. Compared with the control group, the study group presented a longer cumulative duration of glucocorticoid therapy [36.5 (0-168) months vs. 19.0(0-168) months on average, P<0.05], a higher incidence of osteoporosis (29.7% vs. 4.2%, P<0.001), a higher frequency of immune-suppressive therapy (83.9% vs. 64.4%, P=0.035), more organs involveed [median 2 (0-5) vs. 1 (0-4)], and a higher SLE disease activity index (SLEDAI) (14.22±7.40 vs. 11.63±6.11, P<0.05) in univariate logistic regression. The control group had a higher rate of positive Coombs test (39.8% vs. 7.6%, P<0.05). No statistical difference on methylprednisolone (MP) pulse therapy (P>0.05) was observed. Multivariate logistic regression suggested that SLEDAI (OR= 1.070, 95%CI 1.026-1.116, P<0.005), osteoporosis (OR=10.668, 95%CI 3.911-29.103, P<0.001) and a positive Coombs test(OR=0.492, 95%CI 0.266-0.910, P<0.05) were related to the development of ON in SLE patients. Conclusion: A higher disease activity and the presence of osteoporosis are associated with an increased risk of ON in patients with SLE, and positive Coombs test seems a protective factor of ON.


Assuntos
Lúpus Eritematoso Sistêmico , Osteonecrose , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Osteonecrose/epidemiologia , Osteonecrose/etiologia , Estudos Retrospectivos , Fatores de Risco
4.
Zhonghua Yi Xue Za Zhi ; 101(25): 1949-1952, 2021 Jul 06.
Artigo em Chinês | MEDLINE | ID: mdl-34225416

RESUMO

Adult onset Still's disease (AOSD) is a rare polygenic autoinflammatory disease mainly manifesting as high-spiking fever, rash, arthritis/arthralgia, lymphadenopathy, and leukocytosis. More importantly, life threatening macrophage activation syndrome may occur in AOSD patients. Recently, with the development of research in pathogenesis and therapy strategies of biological agents and small molecule targeted drugs, we have new recognition of AOSD. In this commentary, we attempt to place this syndrome in perspective, including data in the past year on pathogenesis, clinical and laboratory features and therapy.


Assuntos
Reumatologistas , Doença de Still de Início Tardio , Adulto , Febre , Humanos , Síndrome
6.
Zhonghua Nei Ke Za Zhi ; 60(5): 453-458, 2021 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-33906275

RESUMO

Objective: Longitudinally extensive transverse myelitis (LETM) could be seen in patients with connective tissue disease (CTD), especially systemic lupus erythematosus (SLE) or primary Sjögren's syndrome (pSS). Some patients are combined with neuromyelitis optica spectrum disorders (NMOSD)(termed CTD-LETM-NMOSD) while others without (termed CTD-LETM-non-NMOSD). The aim of this study is to compare the clinical characteristics of CTD-LETM-NMOSD patients to CTD-LETM-non-NMOSD patients. Methods: We retrospectively collected data from 40 CTD patients with LETM who were admitted to the Department of Neurology or Rheumatology at Peking Union Medical College Hospital from Jan, 2006 to Dec, 2016. They were divided into CTD-LETM-NMOSD and CTD-LETM-non-NMOSD two groups. Demographic characteristics, clinical and laboratory features were obtained from the database. Relapse rates and clinical outcome were analyzed by Kaplan-Meier method. Results: Among 40 patients with CTD, 28 (70.0%) were NMOSD while 12 (30.0%) were not. The positivity rates of anti-SSA, antibodies to aquaporin-4 (anti-AQP4) were significantly higher in patients with NMOSD than those in patients with non-NMOSD (P<0.05). Age, gender, clinical features, disease duration, anti-double-stranded DNA antibody, anti-ribosomal P antibody, antiphospholipid antibodies, expanded disability status scale (EDSS) scores, and magnetic resonance imaging (MRI) features were all comparable between two groups. CTD-NMOSD patients had significantly higher disease relapse rate (75.0% vs. 3/12, P<0.01). Conclusion: Anti-SSA and anti-AQP4 positivity is associated with NMOSD and higher relapse rates, which suggests that NMOSD in CTD-LETM patients may represent distinct characteristics and pathogenesis from patients with CTD-LETM-non NMOSD.


Assuntos
Doenças do Tecido Conjuntivo , Mielite Transversa , Neuromielite Óptica , Aquaporina 4 , Autoanticorpos , Doenças do Tecido Conjuntivo/complicações , Humanos , Recidiva Local de Neoplasia , Neuromielite Óptica/diagnóstico por imagem , Estudos Retrospectivos
7.
Zhonghua Nei Ke Za Zhi ; 60(4): 388-392, 2021 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-33765713

RESUMO

One 51 years old man was admitted to the rheumatology department with a history of prominent eyes, headache and blurred vision for half year. The main manifestations included retrobulbar inflammatory pseudotumor and retroperitoneal fibrosis. He was initially diagnosed as granulomatosis with polyangiitis. Prednisone and cyclophosphamide were administrated and effective. New mass of dura mater and osteosclerosis presented during follow up. Finally Erdheim Chester disease(ECD) was diagnosed by biopsy and pathological examination. Vemurafenib, a v-raf murine sarcoma viral oncogenes homolog B1 (BRAF) inhibitor, 480 mg was given twice a day. The patient's condition is stable and still in follow-up. Although ECD is a rare histiocytosis, clinicians should pay attention to its manifestations and differential diagnoses.


Assuntos
Doença de Erdheim-Chester , Animais , Biópsia , Diagnóstico Diferencial , Doença de Erdheim-Chester/diagnóstico , Cefaleia , Humanos , Masculino , Camundongos , Vemurafenib
9.
Zhonghua Nei Ke Za Zhi ; 60(3): 192-206, 2021 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-33663167

RESUMO

IgG4 related disease (IgG4-RD) is an immune medicated rare disease, characterized with chronic inflammation and fibrosis in the involved organs, it is a systemic disease affected nearly every anatomic site of the body, usually involvement of multiple organs, and with diverse clinical manifestations. Due to the the relative novelty of the disease and under-recognition, the overall level of diagnosis and treatment in China is uneven. Till now, there is no relevant expert consensus or guidance of IgG4-RD in China. In order to further improve the understanding and standardize the management of IgG4-RD, on the basis of summarizing domestic and international experience, the China Alliance For Rare Diseases, together with the Chinese Rheumatology Association, organized an expert group and established the Chinese expert consensus on the diagnosis and treatment of IgG4 related diseases.


Assuntos
Doenças Autoimunes , Reumatologia , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/terapia , China , Consenso , Fibrose , Humanos , Imunoglobulina G
12.
Zhonghua Nei Ke Za Zhi ; 59(12): 953-959, 2020 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-33256336

RESUMO

In recent years, osteoporosis (OP) has become one of the main diseases affecting the health of middle-aged and elderly people in China, and the prevalence of OP has increased significantly. The clinical diagnosis and treatment guidelines for this disease are also constantly updated. The overall principles speciallyemphasise that doctors and patients need to work together to negotiate the details of the diagnosis and treatment guidelines, in order to improve the OP clinical diagnosis and treatment rate. Therefore, patients' knowledge of the disease, understanding of clinical guidelines, and cooperation with doctors to implement diagnosis and treatment plans are very important. In this study, from the most concerned issues of the patients, we established the OP patient practice guideline working group. 14 recommendations, as the OP patient practice guidelines, are proposed in accordance with the relevant principles of the "World Health Organization guidelines development manual" and the international normative process.


Assuntos
Osteoporose , Idoso , China , Humanos , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/terapia , Guias de Prática Clínica como Assunto
13.
Zhonghua Nei Ke Za Zhi ; 59(12): 1013-1016, 2020 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-33256348

RESUMO

A 31-year-old woman was admitted to Peking Union Medical College Hospital presented with intermittent vomiting and abdominal pain for 2 years, and recurrence with paroxysmal dizziness for 1 month. This patient was diagnosed with systemic lupus erythematosus (SLE) 2 years ago with involvement of gastrointestinal and urinary tracts. One month ago, repeated vomiting and nausea recurred. No laboratory and imaging abnormalities were found in central nervous system and gastrointestinal evaluation. Orthostatic hypotension and fluctuation of blood pressure were recorded during hospitalization. Combined with sexual dysfunction, left adie pupil, anhidrosis and abnormal sympathetic skin response, autonomic nerve dysfunction related to SLE was diagnosed. After treated with pulse glucocorticoids and intravenous immunoglobulin, the patient's symptoms improved remarkably. Orthostatic hypotension in SLE patients may link to autonomic nerve dysfunction.


Assuntos
Doenças do Sistema Nervoso Autônomo/complicações , Hipotensão Ortostática/etiologia , Lúpus Eritematoso Sistêmico/complicações , Adulto , Tontura/etiologia , Feminino , Humanos , Hipo-Hidrose/etiologia , Vômito/etiologia
14.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(6): 1056-1062, 2020 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-33331313

RESUMO

OBJECTIVE: To explore the effectiveness and safety of golimumab in the treatment of severe/refractory cardiovascular Behcet syndrome (BS). METHODS: We retrospectively analyzed the clinical data of nine patients diagnosed with severe/refractory cardiovascular BS and treated with golimumab from February 2018 to July 2020 in Peking Union Medical College Hospital. We analyzed levels of erythrocyte sedimentation rate (ESR) and high-sensitivity C-reactive protein (hsCRP), imaging findings, and the doses of glucocorticoids and immunosuppressive agents during the period of combined treatment with golimumab. RESULTS: Nine patients were enrolled, including 8 males and 1 female, with a mean age and median course of (37.0±8.6) years and 120 (60, 132) months, respectively. Seven patients presented with severe aortic regurgitation combined with other cardiovascular involvement secondary to BS. Two patients presented with large vessel involvement, including multiple aneurysms and vein thrombosis. Prior to golimumab treatment, seven patients were treated with glucocorticoids and multiple immunosuppres-sants [with a median number of 3 (1, 3) types] while still experienced disease progression or elevated inflammation biomarkers during postoperative period. Eight patients with disease progression, uncontrolled inflammation and history of severe postoperative complications required effective and fast control of inflammation during perioperative period. One patient had adverse reaction with tocilizumab and switched to golimumab during perioperative period. The patients were treated with golimumab 50 mg every 4 weeks, along with concomitant treatment of glucocorticoid and immunosuppressants. After a median follow-up of (16.3±5.6) months, all the patients achieved clinical improvement. Vascular lesions were radiologically stable and no vascular progressive or newly-onset of vascular lesions was observed. The eight patients who experienced cardiac or vascular operations showed no evidence of postoperative complications. The ESR and hsCRP levels decreased significantly [16.5 (6.8, 52.5) mm/h vs. 4 (2, 7) mm/h, and 21.24 (0.93, 32.51) mg/L vs. 0.58 (0.37, 1.79) mg/L (P < 0.05), respectively]. The dose of prednisone was tapered from 35 (15, 60) mg/d to 10.0 (10.0, 12.5) mg/d. No prominent adverse reactions were observed. CONCLUSION: Our study suggests that golimumab is effective in the treatment of severe/refractory cardiovascular BS. Combination immunosuppression therapy with golimumab contributes to control of inflammation, reduction of postoperative complications and tapering the dose of glucocorticoids or immunosuppressants.


Assuntos
Síndrome de Behçet , Adulto , Anticorpos Monoclonais/uso terapêutico , Síndrome de Behçet/complicações , Síndrome de Behçet/tratamento farmacológico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
Zhonghua Nei Ke Za Zhi ; 59(10): 772-780, 2020 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-32987479

RESUMO

In recent years, the clinical guidelines for the diagnosis and treatment of rheumatoid arthritis (RA) have been constantly updated. Among the general principles, it is particularly emphasized that, in order to improve the ratio of treat to target(T2T) of RA, doctors and patients should work together to negotiate the details of the guidelines. Therefore, it is important for patients to further understand the disease and clinical guidelines of RA, and to better cooperate with doctors. This study was based on the most concerned issues of RA patients and international standard procedure of guideline study, we organized the working group and introduce the following 16 recommendations constituting the RA patients' practice guidelines.


Assuntos
Antirreumáticos , Artrite Reumatoide , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/terapia , Humanos
17.
Zhonghua Nei Ke Za Zhi ; 59(6): 421-426, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32486581

RESUMO

Gout is a crystal associated arthritis caused by monosodium urate (MSU) accumulating in joint, and it belongs to metabolic rheumatic disease. In China, gout is common but it is insufficient for education of standardized diagnosis and treatment for gout. Based on the evidence and guidelines from China and other countries, Chinese gout Collaborative Research Group developed standardization of diagnosis and treatment of gout in China. The purpose is to standardize the methods for diagnosis of gout, treatment opportunity and strategies in order to reduce misdiagnosis, missed diagnosis and irreversible damage.


Assuntos
Gota , Guias de Prática Clínica como Assunto , Ácido Úrico/sangue , China , Gota/diagnóstico , Gota/terapia , Humanos
18.
Zhonghua Nei Ke Za Zhi ; 59(5): 360-365, 2020 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-32370464

RESUMO

Objective: To analyze the clinical and prognostic characteristics in patients with eosinophilic granulomatosis with polyangitis (EGPA). Methods: The clinical data of 146 EGPA patients hospitalized in Peking Union Medical College Hospital from 2000 to 2019 were analyzed retrospectively, including clinical manifestations, laboratory results, treatment, complications and outcome at discharge. Birmingham Vasculitis activity score-V3 (BVAS-V3) was used to evaluate disease activity. Results: The ratio of male to female was 1.8∶1 with average age (41.7±16.1) year-old. The median time from disease onset to diagnosis was 18(6, 60) months (0.5~450). The most common clinical manifestations were lung [121(82.9%)] and nose/paranasal sinuses [119(81.5%)] involvement. The positive rate of anti-neutrophil cytoplasmic antibody (ANCA) was 24.7%, mainly peripheral (P)-ANCA/myeloperoxidase (MPO)-ANCA. Compared with ANCA-negative patients, the ANCA-positive patients had a higher incidence of renal involvement and nervous system involvement (66.7% vs. 20.9%, 80.6% vs. 51.8%, P<0.001), fever and optic neuropathy (66.7% vs. 40.9%,8.3% vs. 0, P<0.05), more active disease [median BVAS-V3 25(18,30)vs. 19(14,24),P=0.001] and more elevated erythrocyte sedimentation rate [40.5(20.5,82.8)mm/1h vs. 25.0(13.3,50.8)mm/1h,P=0.006] and C-reactive protein [37.1(11.8,72.9)mg/L vs.13.5(3.4,66.1)mg/L,P=0.036]. More ANCA-negative patients had pleural effusion (20.9% vs. 5.6%, P<0.04) compared with ANCA-negative patients. Pulmonary infection was the most common complication. A total of 12 EGPA patients (8.2%)achieved remission and 6 patients (4.1%)died or discharged themselves from the hospital. Conclusion: EGPA is a rare small vessel vasculitis. The clinical manifestations and outcomes are heterogenous. The mortality rate of EGPA is high.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos/sangue , Granulomatose com Poliangiite/diagnóstico , Adulto , Eosinófilos , Feminino , Granulomatose com Poliangiite/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Peroxidase , Derrame Pleural , Prognóstico , Estudos Retrospectivos
19.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(4): 253-258, 2020 Apr 09.
Artigo em Chinês | MEDLINE | ID: mdl-32268625

RESUMO

Objective: To study the effects of titania nanotubes with three different diameters on human gingival fibroblast (HGF). Methods: Three groups of specimens were prepared. Titania nanotubes with diameters of 30, 100, and 200 nm were synthesized on titanium surfaces through electrochemical anodization at 10, 30, and 60 V, respectively. Specimens were assigned into the three groups according to the diameter of the titania nanotubes. Pure smooth titanium without any treatment was set as the control group. HGF were seeded on the surface of the samples. The cell morphology on the specimens was observed with immunofluorescence staining after 2 h, the cell adhesion after 2 d and cell proliferation after 1, 3, and 7 d were detected using methyl thiazolyl tetrazolium assay, and the secretion of type Ⅰ collagen after 7 d was determined using enzyme-linked immunosorbent assay (each group has three samples for each experiment). Results: HGF on the control group exhibited an oval shape without noticeable extensions. HGF on titania nanotubes with a diameter of 30 nm and titania nanotubes with a diameter of 100 nm elongated further and were arranged orderly. HGF on titania nanotubes with a diameter of 200 nm were sparsely distributed without noticeable extensions. Titania nanotubes with a diameter of 30 nm and titania nanotubes with a diameter of 100 nm could enhance the cell attachment (0.603±0.021 and 0.773±0.045), and secretion of type Ⅰ collagen [(36.5±9.5) and (47.7±4.5) µg/ml, respectively] compared with the control group whose cell attactment was 0.427±0.057, and secretion of type Ⅰ collagen was (22.2±5.9) µg/ml (P<0.05). Furthermore, titania nanotubes with a diameter of 100 nm showed more cell attchment than titania nanotubes with a diameter of 30 nm did (P<0.05). Ttania nanotubes with a diameter of 200 nm clearly impaired the cell adhesion (0.250±0.046) and secretion of type Ⅰ collagen [(10.1±3.7) µg/ml] compared with the control group (P<0.05). At each time point, titania nanotubes with a diameter of 100 nm showed the highest cell proliferation, and the amount of cell proliferation was significantly higher than that on the titania nanotubes with a diameter of 200 nm and the control group at each time point (P<0.05), and was also significantly higher than that on the titania nanotubes with a diameter of 30 nm at day three (P<0.05). At each time point, titania nanotubes with a diameter of 200 nm showed the lowest cell proliferation, which was significantly lower than that on the control group at each time point (P<0.05), except that there was no significant difference in the amount of cell proliferation between titania nanotubes with a diameter of 200 nm and the control group at day one (P>0.05). Conclusions: Titania nanotubes with a diameter of 100 nm can improve the HGF attachment, proliferation, and secretion of type Ⅰ collagen.


Assuntos
Adesão Celular , Proliferação de Células , Fibroblastos/efeitos dos fármacos , Gengiva/efeitos dos fármacos , Nanotubos , Titânio/farmacologia , Colágeno Tipo I/metabolismo , Humanos , Propriedades de Superfície
20.
Zhonghua Nei Ke Za Zhi ; 59(4): 269-276, 2020 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-32209192

RESUMO

Sjögren's syndrome is a chronic systemic autoimmune disease characterized by lymphocyte proliferation and progressive exocrine gland damage. In China, standardized diagnosis and treatment for Sjögren's syndrome lags behind other common rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus. Based on the evidence and guidelines from China and other countries, Chinese Sjögren's Syndrome Collaborative Research Group together with stomatologist and ophthalmologist developed Standardization of diagnosis and treatment of primary Sjögren's syndrome. The purposes are: (1) to standardize the detection and interpretation of key indicators for the diagnosis of Sjögren's syndrome, including serum anti SSA antibody and labial gland pathology; (2) to suggest using widely accepted disease activity index in evaluation of the disease; (3) to standardize rational management for Sjögren's syndrome patients with topical and systemic diseases.


Assuntos
Guias de Prática Clínica como Assunto , Síndrome de Sjogren , China , Humanos , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/terapia
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