1998年 · 第111卷第03期

OBJECTIVE To test anti-Sa antibody in different autoimmune connective tissue diseases and analyze the relationship between Sa antibody and clinical manifestations and laboratory tests in rheumatoid arthritis. METHODS Sa antigen was extracted from human placenta. Anti-Sa antibody was tested in 40 normal people and 478 connective tissue disease (CTD) patients using Western Blotting (WB). RESULTS Sa antigen was a protein with molecular weights of 50 kD and 55 kD. Anti-Sa antibody was positive in 31.9% (61/191) rheumatoid arthritis (RA), 3.0% (2/67) Sjögren's syndrome (SS), 4.3% (2/46) systemic lupus erythmatosus (SLE) and 0% (0/66) Behcet's disease, 0% (0/60) polymyositis/dermatomyositis (PM/DM), 0% (0/66) other CTD and 0% (0/40) normal controls. Anti-Sa antibody was different from other auto-antibodies in RA. In rheumatoid arthritis its sensitivity, specificity, positive prediction rate, negative prediction rate were 31.9%, 98.6%, 93.8% and 68.5% respectively. Anti-Sa antibody positive patients were significantly different from anti-Sa antibody negative patients in moming stiffness, ESR, ANA and X-ray grade. CONCLUSIONS Anti-Sa antibody was a new auto-antibody for the diagnosis of RA. Anti-Sa antibody positive patients seem to have more serious inflammation and more advanced disease process.

OBJECTIVE To detect HLA-DRB1 (DR1-10) alleles in 5 families with multi-case rheumatic diseases, and to study the possible influence of DRB1 genes in the pathogenesis of rheumatic diseases. METHODS Sequence-Specific Primer PCR (PCR-SSP) method was used to examine HLA-DRB1 alleles. Totally 36 members of 5 families and 166 healthy people were involved in this study. The RESULTS were assessed by Chi-square test. RESULTS The HLA-DRB1 allele frequency in the patients and their relatives was similar. No significant difference was found. But DR4 allele frequency in the patients (90.9%) and their relatives (68%) was much higher than that in normal controls (16.8%) and the difference was statistically significant (P<0.0001). In family 4, two RA patients have different DRB1 alleles, while in family 5, two patients have the same DRB1 alleles, one developed SLE and the other developed RA. CONCLUSIONS DR4 is closely related to rheumatoid arthritis. The nelatives of RA patients may be at greater risk to develop RA than individuals without family history. Some patients had the same DRB1 allele but developed different rheumatic diseases. This suggested that there might be some common pathways in genetic predisposing of rheumatic diseases. On the other hand, only a few patients with the same DRB1 allele developed rheumatic diseases during their life, so other factors besides DRB1 gene might also be involved in the pathogenesis of rheumatic diseases.

OBJECTIVE To investigate the location and expression of Fas (Apo-1, CD-95) antigen in synovial tissue from rheumatoid arthritis (RA). METHODS Immunohistochemical technique was used to identify the location and expression of Fas antigen in synovial tissues from 27 RA, 11 osteoarthritis (OA), 7 ankloysing spondylitis (AS), 3 pigmented villo-hyperplastic synovitis, 1 juvenile rheumatoid (JRA) patients and 5 "normal" control subjects. RESULTS Fas was strongly expressed by synoviocytes and infiltrated lymphocytes in approximately two-thirds of RA patients (16/27). However, only weak expression occurred on lymphocytes in 3 of 11 OA, 1 of 7 AS patients and 1 of 5 "normal" subjects. The stain-positive substance in the forms of rings, granules, or dust was deposited on the cell membrane and in cytoplasm. CONCLUSIONS The expression of Fas may be involved in the mechanism of synovium proliferation and abnormal activation of local lymphocytes in RA.

OBJECTIVE To explicate whether mixed connective tissue disease (MCTD) is a distinct disease and evaluate the reliability of three different diagnostic criteria proposed by Sharp, Alarcon-Segovia and Kasukawa respectively. METHODS Clinical follow-up of 50 MCTD patients lasted 2-8 years (80%>5 years). HLA-A, -B as well as -DR typing was performed by complemently dependent cytotocity assay. Autoantibody profile was detected by counterimmune electrophoresis (CIE). RESULTS Thirteen (26.0%) of the 50 MCTD patients subsequently developed other connective tissue disease (OCTD), including 7 systemic lupus erythematosis (SLE), and 6 progressive systemic scleroderma (PSS). Among 23 of the MCTD patients fulfilling Sharp's criteria, 1 (4.3%) developed PSS, but among 23 of the patients fulfilling Kasukawa's, not Sharp's, 7 (30.4%) developed OCTD and among 27 of the patients fulfilling Alarcon-Segovia's, not Sharp's, 12 (44.4%) developed OCTD. In the frequencies of DR4 and DR5, there were significant differences between patients fulfilling Sharp's (60.9%, 56.5%) and controls (24.3%, P<0.005, RR = 4.7 and 21.4%, P<0.005, RR = 4.6%), but there were no significant differences between the patients not fulfilling Sharp's and normal control (P>0.05). CONCLUSIONS MCTD is a distict rheumatic disease. Sharp's criteria is the most reliable for diagnosis of MCTD.

OBJECTIVE To evaluate the incidence and spectrum of malignancy of primary Sjögren's syndrome (pSS). METHODS 250 pSS who were followed-up in Peking Union Medical College (PUMC) Hospital were analyzed. RESULTS Four of them were diagnosed with histopathological findings of 2 non-Hodgkin Lymphoma, 1 AILD, 1 multiple myeloma. Two died of secondary infection while receiving chemotherapy for lymphoma, 2 remained remitted. CONCLUSIONS The risk factors were persistent enlargement of major salivary glands, appearance of monoclonal serum lg, and disappearance of auto antibodies.

OBJECTIVE To evaluate the incidence, severity, clinical manifestations and immunological features relevant to liver involvement in 135 cases of primary Sjögren's syndrome. METHODS One hundred and thirty-five patients with definite primary Sjögren's syndrome were analyzed retrospectively for liver involvement by the abnormalities of the liver enzymes, bilirubin level and liver biopsied section. RESULTS The liver involvement in 30 patients (22.2%) could be etiologically ascribed to Sjögren's syndrome itself. The clinical spectrum and severity of this entity differed widely, 36.6% showed no relevant clinical symptoms, however jaundice was found in 46.7% of patients. Six patients showed pathological changes of chronic active hepatitis. 73.3% of all patients with liver involvement responded to steroid and immunosuppressive drugs, yet with a tendency to relapse (two cases). Liver cirrhosis was developed in five cases. The spectrum of serum autoantibodies in the patients with liver involvement showed no difference from those without liver involvement. Most of them were compatible with the serum profile of autoimmune hepatitis type-1. CONCLUSIONS Liver involvement was complicated in 22.2% patients of primary Sjögren's syndrome. Clinical manifestations were non-specific and the main pathological change was chronic active hepatitis. The differential diagnosis between Sjögren's syndrome with liver involvement and type-1 autoimmune hepatitis could be only ascribed to other systemic clinical manifestations of Sjögren's syndrome.

OBJECTIVE To assess the incidence of renal involvement in patients with systemic sclerosis (SSc) as well as its clinical and pathological changes. METHODS The renal involvement was studied clinicopathologically in 93 patients who were compatible with the diagnosis of SSc retrospectively. RESULTS Eighteen patients (19.4%) were diagnosed as renal involvement by one or more of the following: proteinuria, renal hypertension, elevated levels of blood urea nitrogen (BUN) and/or serum creatinine (sCr). Renal impairment was observed in 5 patients (5.4%). The mortality rate was 12.9%, and 5 patients died of renal failure. Histological study was performed in 5 patients. The thickening of interlobular arterioles with intimal proliferation was found in 4 of the patients who also showed mild nonspecific glomerular changes. Two had no clinical features of renal involvement, 1 had renal hypertension and 1 died of renal failure. Another patient with a 22-year disease duration showed chronic glomerulonephritis with nephrosclerosis. CONCLUSIONS SSc patients should be followed-up clinically and renal biopsy performed if necessary in order to discover early renal involvement and to insert rational therapy to improve its prognosis.

OBJECTIVE To investigate the prevalence of hyperuricemia and gout in a community population of Huangpu District in Shanghai. METHODS In the target community, 2037 dwellers were interviewed with relevan questionnares from house to house. According to even house number 1017 blood samples were taken for serum uric acid (SUA) levels measured with the uricase-peroxidase enzymatic method. RESULTS The prevalence of hyperuricemia was 14.2% in men (SUA>70 mg/L, 62 cases), 7.1% in women (SUA>60 mg/L, 41 cases), 10.1% in both sexes. Seven gout patients were all men. The prevalence of gout in 2037 dwellers in Huangpu District was 0.77% in men and 0.34% in both sexes. CONCLUSIONS The mean SUA level in each age group in this survey was much higher than that of a previous study 1 carried out in Shanghai, Beijing and Guangzhou in 1980 (P<0.05). And the prevalence of hyperuricemia was increased rapidly (in men: from 1.4% in the survey of 1980 to 14.2% in our survey; in women: from 1.3% in the survey of 1980 to 7.1% in our survey). Compared with Idonesia data in 1992, the prevalence of hyperuricemia and gout in our survey was lower than that in Indonesia (P<0.05), which suggests that racial and genetic predispositions are key causative factors.

OBJECTIVE To investigate the effect of previous open heart operations (POHO) on the outcome of heart transplantation (HTX). METHODS Between November 1984 and May 1996, HTX was performed on 151 patients at Hartford Hospital. Among them, 61 patients had previous open heart operations (POHO) (group A), and 90 did not (group B). The average follow-up period was 1615±1185 days for group A and 1330±1125 days for group B. The recipient age was 55±10 years for group A and 48±12 years for group B (P<0.01). There were 17 patients (26%) in group A and 14 (50%) in group B who were over 60 years of age. There was more coronary artery disease (74% versus 37%, P<0.001) as etiology, and more diabetics in group A (P<0.02). RESULTS The time for cardiopulmonary bypass (133±20 min versus 106±18 min, P<0.01) and aortic clamp time (73±16 min versus 61±13 min, P<0.01) were longer in group A. The operative mortality (within 30 days) was 0 and 2.2%, and the cumulative deaths were 16 (26%) and 43 (48%) respectively for group A and group B (P<0.01). The causes of death were (group A vs group B): infection (31% vs 26%), rejection (13% vs 28%, P<0.05), malignancy (25% vs 16%), cardiac event (6% vs 14%) and others (25% vs 16%). In patients over 60, there were 4 deaths (24%) in group A and 7 (50%) in group B. The difference was not significant. No patients died of rejection in this subgroup. The actuarial survival rates in group A versus group B were: 1 year, 93% versus 83%; 2 years, 85% versus 74%; 3 years, 81% versus 71%; 5 years, 76% versus 58%; and 10 years, 57% versus 24% (P<0.01). CONCLUSIONS The survival rate in patients who had POHO is much higher than that in patients who had HTX as their primary operation.

OBJECTIVE To observe the characteristics of folate binding proteins (FBP) in myelodysplastic syndromes (MDS) and leukemia and to study the clinical significance of reduced folate carrier (RFC) present in MDS and its relationship with multidrug resistance (MDR). METHODS The features of FBP on bone marrow cells were analyzed using radiolabeled 3H-folic acid (3H-FA) binding membrane proteins and SDS-polyacrylamide gel electrophoresis (SDS-PAGE). In the same time, P-glucoprotein and mRNA of MDR gene were detected using immunocytochemistry and reverse transcription polymerase chain reaction (RT-PCR) respectively in patients with MDS and leukemia. RESULTS Two kinds of FBP, folate receptor (FR) and reduced folate carrier (RFC), were found on the leukemic cells. The same RESULTS were presented on mononuclear cells of bone marrow in 5 out of 14 MDS patients, and MDR positive was seen in 4 patiens of them. In normal control and other 9 cases of MDS FRs were only found on the mononuclear cells of bone marrow. CONCLUSIONS Reduced folate carrier, which is present in the leukemic cell, is a product of neoplastic cell. It might reveal preleukmic state and have the same significance with MDR that RFC is found in MDS patients.

Rheumatology was for a long time a highly neglected area of medicine in China. The first rheumatology unit in the department of medicine was established in the Peking Union Medical College Hospital in 1980. Prior to that, little was known about the epidemiology of rheumatic diseases in China.

Secretion of pineal melatonin exhibits a diumal rhythm and a seasonal rhythm in humans. Night-time melatonin is high at 3-5 year-old and decreases with age. Many drugs and pathological conditions also change melatonin levels in the circulation. Melatonin has a mild sedative effect and has been used effectively in synchronizing the sleep-wake cycle of patients with sleep disorders. Immunoenhancing, anti-cancer, anti-aging and anti-oxidant effects of melatonin have been proposed. Recent studies suggest that melatonin receptors are present in central and peripheral tissues. The importance of melatonin receptors on the nervous, reproductive, immune and renal functions is implicated. Studies on the molecular biology, physiology and pathology of melatonin receptors in different tissues are progressing rapidly. The physiological and pathological changes in melatonin secretion, multifarious melatonin actions, and diverse melatonin receptors reported suggest that melatonin is a photoperiodic signal with clinical significance in humans.

Billroth I operation is the best procedure to do the subtotal gastrectomy for duodenal ulcer. It restores the gastroduodenal continuation and decreases complications. In the past, however, when there were too many scars in the ulcer, only Billroth II operation was performed.

The book of "Neonatal and Perinatal Screening--The Asian Pacific Perspective" is the proceedings of the Second Asian Pacific Regional Meeting of The International Society of Neonatal Screening (ISNA) which was held in Hong Kong from November 28 to December 1, 1995.

To explore the injury process of the liver sinusoidal endothelial cells, the modified isolated liver perfusion (ILP) model with large doses of 5-Fu for chenmotherapy was established in rats.

Abstract of Current Chinese Medical Literature

Abstract of Current Chinese Medical Literature

Abstract of Current Chinese Medical Literature