BACKGROUND Proliferative lupus nephritis(PLN)is the most severe form of lupus nephritis(LN).There are limited data available on renal outcomes of PLN from developing countries.AIM To determine the clinicopathological ...BACKGROUND Proliferative lupus nephritis(PLN)is the most severe form of lupus nephritis(LN).There are limited data available on renal outcomes of PLN from developing countries.AIM To determine the clinicopathological characteristics and long-term outcomes in terms of remission,requirement of kidney replacement therapy(KRT),and patient survival.METHODS A retrospective analysis was conducted on biopsy-proven focal or diffuse PLN cases diagnosed between 1998 and 2019 at the Sindh Institute of Urology and Transplantation and followed up at the renal clinic for a minimum of 5 years.All patients were induced with a combination of intravenous cyclophosphamide and corticosteroids for 6 months,followed by maintenance treatment with azathioprine(AZA)or mycophenolate mofetil(MMF).Data were analyzed using Statistical Package for the Social Sciences,version 22.0.P≤0.05 was considered statistically significant.RESULTS The mean age at the onset of systemic lupus erythematosus was 24.12 years±8.89 years,and at LN onset,26.63 years±8.61 years.There was a female predominance of 184(88.9%)cases.Among baseline characteristics,reduced estimated glomerular filtration rate,presence of hypertension,requirement of KRT,and underlying renal histology(International Society of Nephrology/Renal Pathology Society class IV than class III)were significantly associated with end-stage kidney disease(ESKD)and mortality.The renal outcomes were negatively correlated with age,duration of symptoms,and 24-hour urinary protein excretion.The overall remission rate was 89.8%at the end of induction therapy.At 5 years,141(68.11%)patients were in complete and partial remission(94[45.4%]and 47[22.7%],respectively).In total,19(9.2%)patients required KRT on presentation,and at 5 years,38(18.4%)patients developed ESKD,and 28(13.5%)patients died.Thirty-four(16.4%)patients had a renal relapse,more with AZA than MMF(30[88.2%]vs 4[11.76%],respectively;P=0.04).Renal survival at 6 months was 89.8%,while at 5 years,it was 68.11%,showing a significant improvement in patients who did not need KRT at the time of presentation(P<0.0001).CONCLUSION Baseline renal functions,requirement of KRT,and diffuse proliferative disease were the most relevant prognostic factors for kidney survival among this cohort.Short-term renal outcomes were good.Long-term outcomes were poorer with AZA-based maintenance therapy than with MMF,with more ESKD and mortality.展开更多
Objective This study aims to investigate the exosome-derived metabolomics profiles in systemic lupus erythematosus(SLE),identify differential metabolites,and analyze their potential as diagnostic markers for SLE and l...Objective This study aims to investigate the exosome-derived metabolomics profiles in systemic lupus erythematosus(SLE),identify differential metabolites,and analyze their potential as diagnostic markers for SLE and lupus nephritis(LN).Methods Totally,91 participants were enrolled between February 2023 and January 2024 including 58 SLE patients[30 with nonrenal-SLE and 28 with Lupus nephritis(LN)]and 33 healthy controls(HC).Ultracentrifugation was used to isolate serum exosomes,which were analyzed for their metabolic profiles using liquid chromatography–tandem mass spectrometry(LC–MS/MS).Endogenous metabolites were identified via public metabolite databases.Random Forest,Lasso regression and Support Vector Machine Recursive Feature Elimination(SVM-RFE)algorithms were employed to screen key metabolites,and a prediction model was constructed for SLE diagnosis and LN discrimination.ROC curves were constructed to determine the potential of these differential exosome-derived metabolites for the diagnosis of SLE.Furthermore,Spearman’s correlation was employed to evaluate the potential links between exosome-derived metabolites and the clinical parameters which reflect disease progression.Results A total of 586 endogenous serum exosome-derived metabolites showed differential expression,with 225 exosome-derived metabolites significantly upregulated,88 downregulated and 273 exhibiting no notable changes in the HC and SLE groups.Machine learning algorithms revealed three differential metabolites:Pro-Asn-Gln-Met-Ser,C24:1 sphingolipid,and protoporphyrin IX,which exhibited AUC values of 0.998,0.992 and 0.969 respectively,for distinguishing between the SLE and HC groups,with a combined AUC of 1.0.In distinguishing between the LN and SLE groups,the AUC values for these metabolites were 0.920,0.893 and 0.865,respectively,with a combined AUC of 0.931,demonstrating excellent diagnostic performance.Spearman correlation analysis revealed that Pro-Asn-Gln-Met-Ser and protoporphyrin IX were positively correlated with the SLE Disease Activity Index(SLEDAI)scores,urinary protein/creatinine ratio(ACR)and urinary protein levels,while C24:1 sphingolipid exhibited a negative correlation.Conclusions This study provides the first comprehensive characterization of the exosome-derived metabolites in SLE and established a promising prediction model for SLE and LN discrimination.The correlation between exosome-derived metabolites and key clinical parameters strongly indicated their potential role in SLE pathological progression.展开更多
BACKGROUND Not all neuropsychiatric(NP)manifestations in patients with systemic lupus erythematosus(SLE)are secondary to lupus.The clarification of the cause of NP symptoms influences therapeutic strategies for SLE.AI...BACKGROUND Not all neuropsychiatric(NP)manifestations in patients with systemic lupus erythematosus(SLE)are secondary to lupus.The clarification of the cause of NP symptoms influences therapeutic strategies for SLE.AIM To understand the attribution of psychiatric manifestations in a cohort of Chinese patients with SLE.METHODS This retrospective single-center study analyzed 160 inpatient medical records.Clinical diagnosis,which is considered the gold standard,was used to divide the subjects into a psychiatric SLE(PSLE)group(G1)and a secondary psychiatric symptoms group(G2).Clinical features were compared between these two groups.The sensitivity and specificity of the Italian attribution model were explored.RESULTS A total of 171 psychiatric syndromes were recorded in 138 patients,including 87 cases of acute confusional state,40 cases of cognitive dysfunction,18 cases of psychosis,and 13 cases each of depressive disorder and mania or hypomania.A total of 141(82.5%)syndromes were attributed to SLE.In contrast to G2 patients,G1 patients had higher SLE Disease Activity Index-2000 scores(21 vs 12,P=0.001),a lower prevalence of anti-beta-2-glycoprotein 1 antibodies(8.6%vs 25.9%,P=0.036),and a higher prevalence of anti-ribosomal ribonucleoprotein particle(rRNP)antibodies(39.0%vs 22.2%,P=0.045).The Italian attribution model exhibited a sensitivity of 95.0%and a specificity of 70.0%when the threshold value was set at 7.CONCLUSION Patients with PSLE exhibited increased disease activity.There is a correlation between PSLE and anti-rRNP antibodies.The Italian model effectively assesses multiple psychiatric manifestations in Chinese SLE patients who present with NP symptoms.展开更多
Lupus nephritis(LN)is one of the most common and serious complications of systemic lupus erythematosus,which can lead to end-stage renal disease,and is an important cause of death in patients with systemic lupus eryth...Lupus nephritis(LN)is one of the most common and serious complications of systemic lupus erythematosus,which can lead to end-stage renal disease,and is an important cause of death in patients with systemic lupus erythematosus.Treatment options include glucocorticoids,immunosuppressive agents and the addition of biologics.Recently,the therapeutic role of mesenchymal stem cells(MSCs)in LN has received extensive attention worldwide.MSCs can suppress autoimmunity,alleviate proteinuria and restore renal function by modulating the functions of various immune cells and reducing the secretion of inflammatory cytokines.Several clinical trials have investigated MSC treatment in LN with promising but sometimes inconsistent outcomes.This review summarizes the sources of MSCs and mechanisms in immunoregulation.Furthermore,it examines clinical trials evaluating the efficacy,safety,and limitations of MSC therapy in LN.By highlighting advances and ongoing challenges,this review underscores the potential of MSCs for LN treatment.More large-scale randomized controlled trials are needed to support the effectiveness of this therapy and pave the way for personalized and combinatorial therapeutic approaches.展开更多
BACKGROUND Systemic lupus erythematosus(SLE)can affect multiple organs or systems.The involvement of the central nervous system can result in the manifestation of epilepsy,an acute confusional state,and other rare neu...BACKGROUND Systemic lupus erythematosus(SLE)can affect multiple organs or systems.The involvement of the central nervous system can result in the manifestation of epilepsy,an acute confusional state,and other rare neuropsychiatric presentations,such as catatonia.CASE SUMMARY We present a case of an adolescent male patient with first-onset SLE who presented with neuropsychiatric symptoms including epilepsy and delirium.The initial utilization of olanzapine to alleviate symptoms of agitation precipitated the emergence of catatonia,which was mitigated by discontinuing olanzapine and supplementing with lorazepam.In this case,whether the catatonia was secondary to the utilization of antipsychotics or to an organic disease is a question that warrants differential diagnosis.CONCLUSION Multidisciplinary collaborative management is the cornerstone for the successful management of severe cases of SLE.展开更多
Objective To review and synthesize preclinical and clinical evidence regarding traditional Chinese medicine(TCM)formulations and bioactive herbal compounds in lupus nephritis(LN),and to identify direction and research...Objective To review and synthesize preclinical and clinical evidence regarding traditional Chinese medicine(TCM)formulations and bioactive herbal compounds in lupus nephritis(LN),and to identify direction and research priorities for integrating TCM with professional care.Methods A narrative literature review was conducted by searching Scopus,PubMed,Web of Science,and Google Scholar for articles published between January 1,2011 and March 31,2024.Search terms combined controlled vocabulary[e.g.,medical subject headings(MeSH)]and free-text words including lupus nephritis,traditional Chinese medicine,Chinese herbal medicine,formulation,and names of specific herbs[Leigongteng(Tripterygii Wilfordii Radix et Rhizoma),Baishao(Paeoniae Radix Alba),and Yinghao(Artemisiae Annuae Herba)].Both randomized controlled trials and observational studies were included,along with mechanistic preclinical studies and pharmacologic investigations.Inclusion criteria were studies that reported renal outcomes(proteinuria and estimated glomerular filtration rate),immunemodulatory mechanisms,or safety and herb-drug interaction data.Studies without primary data,case reports,or those lacking relevance to LN were excluded.References of key articles were manually screened to identify additional eligible studies.Results TCM formulas[e.g.,Liuwei Dihuang Pills(六味地黄丸),Zhibai Dihuang Pills(知柏地黄丸),and Huanglian Jiedu Decoction(黄连解毒汤)]and herbal medicines[e.g.,extracts from Leigongteng(Tripterygii Wilfordii Radix et Rhizoma),Baishao(Paeoniae Radix Alba),and Yinghao(Artemisiae Annuae Herba)]were commonly used in the above studies.TCM formulations and their constituent compounds showed multi-modal mechanisms relevant to LN pathogenesis,encompassing immunomodulation(reduction of autoreactive B/T cell activity,regulatory T cell enhancement),inhibition of pro-inflammatory signaling pathways nuclear factor kappa-light-chain-enhancer of activated B cells(NF-κB),mitogen-activated protein kinase(MAPK),nucleotide-binding oligomerization domain(NOD),leucine-rich repeat(LRR)and pyrin domain-containing protein 3(NLRP3 inflammasome),anti-fibrotic and antioxidant effects,and direct renal-protective properties.In many studies,these indicators can reduce proteinuria and improve renal function.Clinical data,while promising,are heterogeneous in design,sample size,endpoints,and TCM formulation standardization.Safety concerns(notably with Tripterygium preparations)and potential herb-drug interactions with immunosuppressants remained important considerations.Conclusion TCM offers biologically plausible and multi-targeted adjuvant strategies for LN that may enhance therapeutic efficacy and reduce toxicity when combined with modern therapies.To translate these promises into clinical practice,future work should prioritize the standardization of TCM preparations,randomized controlled trials with clinically meaningful renal endpoints,elucidation of molecular mechanisms,and systematic evaluation of pharmacokinetic and safety interactions.Such integrative research will be essential to define the TCM’s role in evidence-based,patient-centered LN management.展开更多
AIM:To summarize and quantitatively evaluate vasculature alteration of foveal zone in systemic lupus erythematosus(SLE)patients by secondary literature analysis.METHODS:A systematic search of PubMed,Embase,Web of Scie...AIM:To summarize and quantitatively evaluate vasculature alteration of foveal zone in systemic lupus erythematosus(SLE)patients by secondary literature analysis.METHODS:A systematic search of PubMed,Embase,Web of Science,Cochrane Library,CBM,CNKI WanFang Data and VIP was conducted.Studies were about retinal vessel density in SLE patients from January 2000 to April 2023 and valid data were extracted.The Joanna Briggs Institute(JBI)critical appraisal checklist was used to evaluate the cross-sectional studies and prospective studies.The measurement data for combined effect size were weighted mean difference(WMD)and 95%confidence interval(CI).The heterogeneity was evaluated by I2 test.The fixed-effect model was adopted when P>0.1 or I2<50%,and random-effect model was adopted in the contrary.Subgroup and sensitivity analysis were utilized to analyze the sources of heterogeneity.The publication bias was evaluated by Egger tests and funnel plots.RESULTS:A total of 14 studies with 445 subjects and 441 healthy controls from 9 countries were enrolled and 11 studies were included in Meta-analysis.The JBI scores of studies were no less than 14 points.The Metaanalysis results indicated that mean parafoveal superficial vessel density(SVD;WMD=-1.22,95%CI:-1.67,-0.76),mean perifoveal SVD(WMD=-1.42,95%CI:-1.95,-0.89),mean whole SVD(WMD=-1.66,95%CI:-2.53,-0.79),mean parafoveal deep vessel density(WMD=-1.67,95%CI:-2.75,-0.59)and mean whole deep vessel density(WMD=-4.09,95%CI:-7.67,-0.52)was significantly lower than the control,while mean foveal SVD(WMD=-1.71,95%CI:-4.65,1.24),mean foveal avascular zone(FAZ)area(WMD=0.04,95%CI:-0.01,0.09)and mean acircularity index(AI;WMD=0.00,95%CI:-0.02,0.02)were not different between SLE patients and controls.Subgroup analysis indicated that the heterogeneity in SVD was partially due to the scanning area.Ocellus or binoculus data contributed partially to the heterogeneity in parafoveal deep vessel density and FAZ area.Sensitivity analysis indicated that the results were robust after changing the analysis model except for foveal SVD and FAZ area.There was no bias in included studies except whole SVD.CONCLUSION:Parafoveal superficial and deep vessel density are significantly lower in SLE patients while FAZ area and AI are not different between SLE patients and the control.展开更多
Pediatric lupus nephritis(LN)is a challenging and severe condition in pediatrics.Traditional Chinese medicine(TCM)has shown significant advantages in improving immune disorders,reducing recurrence rates,and mitigating...Pediatric lupus nephritis(LN)is a challenging and severe condition in pediatrics.Traditional Chinese medicine(TCM)has shown significant advantages in improving immune disorders,reducing recurrence rates,and mitigating the toxic side effects of Western medications.However,it faces challenges such as the lack of a unified TCM syndrome differentiation system,insufficient standardization of dynamic syndrome differentiation,an incomplete efficacy evaluation system,and a lack of precise intervention methods.This study focuses on the clinical advantages of TCM.On 1 September 2024,the 35th Clinical Advantage Disease Series Salon was held in Zhengzhou,discussing the advantages of TCM and integrated Chinese-Western medicine in treating pediatric LN.Experts in TCM and integrated Chinese-Western medicine,along with interdisciplinary researchers,conducted extensive and in-depth discussions.They proposed specific recommendations for TCM and integrated Chinese-Western medicine in treating pediatric LN and reached a consensus.Based on this,the study analyzes the challenges in treating pediatric LN from the perspective of its development patterns,and summarizes three key areas and six research directions to highlight the advantages of TCM and integrated Chinese-Western medicine in treating pediatric LN.It focuses on three key areas:The construction of a TCM system for pediatric LN,the prevention and treatment of complications,and chronic disease management.And it proposes six research directions:(1)Constructing a syndrome differentiation system for pediatric LN;(2)Formulating TCM and integrated Chinese-Western medicine guidelines for pediatric LN;(3)Researching the mechanisms of enhancing efficacy and reducing toxicity in integrated Chinese-Western medicine for pediatric LN;(4)Preventing and treating complications in pediatric LN;(5)Developing and researching TCM regimens for preventing and treating the recurrence of pediatric LN;(6)Strategies for the full-cycle chronic disease management of pediatric LN.Finally,the study summarizes and generalizes the technological layout and research directions for pediatric LN.Therefore,based on the series of salons on traditional Chinese medicine advantages for children LN diseases,this paper puts forward a research paradigm of scientific and technological breakthroughs for children LN,in order to provide reference for the construction and research direction of children LN diagnosis and treatment system with traditional Chinese medicine characteristics.展开更多
AIM:To evaluate the choroidopathy in patients with systemic lupus erythematosus(SLE)using enhanced depth imaging spectral domain optical coherence tomography(EDI SD-OCT)and optical coherence tomography angiography(OCT...AIM:To evaluate the choroidopathy in patients with systemic lupus erythematosus(SLE)using enhanced depth imaging spectral domain optical coherence tomography(EDI SD-OCT)and optical coherence tomography angiography(OCTA).METHODS:A total of 74 patients with SLE and 40 healthy volunteers were included in this cross-sectional study.SLE patients were further divided into three subgroups based on clinical and blood biochemistry findings.Ocular parameters obtained on ophthalmologic examination and optical imaging(EDI SD-OCT and OCTA)included the best corrected distance visual acuity(logMAR CDVA),subfoveal choroidal thickness(SCT),choroidal vascularity index(CVI)and vessel density(VD)of superficial capillary plexus(SCP)and deep capillary plexus(DCP).RESULTS:SLE patients had significantly lower values for CVI and VD of DCP(DVD)than control subjects.Amongst SLE patients,gender and chloroquine dose were found to be independent determinants of CVI while age predicted SCT.Steroid dose was a significant predictor for foveal VD of SCP(SVD),chloroquine dose for parafoveal SVD,gender for total DVD,and gender and steroid dose for perifoveal DVD.No correlation of logMAR CDVA and SCT was noted between SLE patients and control subjects.No correlation of SCT was noted with disease duration,Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score,hydroxychloroquine(HCQ)dose or steroid dose.No correlation of CVI was noted with patient age,disease duration,SLEDAI score,HCQ dose or steroid dose.No significant difference was noted between SLE subgroups in terms of any of the ocular parameters studied.CONCLUSION:The findings reveal the presence of ocular findings suggestive of early onset choroidopathy on EDI SD-OCT and OCTA in SLE patients,in the absence of ocular manifestations or active disease.展开更多
Pregnancy in women with lupus,particularly those with lupus nephritis(LN),carries an increased risk of adverse outcomes.Women with active LN at the time of conception are at a high risk of poor maternal and fetal outc...Pregnancy in women with lupus,particularly those with lupus nephritis(LN),carries an increased risk of adverse outcomes.Women with active LN at the time of conception are at a high risk of poor maternal and fetal outcomes.Recent studies indicate that even in the presence of quiescent disease,factors such as hypertension and positive lupus anticoagulant are predictors of worse pregnancy outcomes.Consequently,pre-conception evaluation is essential to ensure that pursuing pregnancy is safe and timely,and to facilitate proper planning for optimizing medical regimens,discontinuing teratogenic agents,and treating active disease.Additionally,pre-existing LN is associated with higher rates of preeclampsia and hemolysis,elevated liver enzymes,and low platelet count syndrome.Women with lupus and prior LN can have successful pregnancies,but a multidisciplinary approach with close monitoring is essential for optimal outcomes.By systematically reviewing the available evidence,this narrative review aims to provide a comprehensive update on the complex interaction between LN and pregnancy,offering insights to guide clinical practice and future research in this field.展开更多
The intersection of cutaneous lupus erythematosus (CLE) and osteonecrosis highlights a complex relationship between dermatologic and orthopedic pathology, underscoring the systemic nature of autoimmune disease. Osteon...The intersection of cutaneous lupus erythematosus (CLE) and osteonecrosis highlights a complex relationship between dermatologic and orthopedic pathology, underscoring the systemic nature of autoimmune disease. Osteonecrosis, characterized by ischemic bone death and subsequent joint degeneration, is a known complication in systemic lupus erythematosus (SLE), but emerging evidence suggests that CLE manifestations may serve as early indicators or contributory factors in its development. Chronic inflammation and microvascular injury, central to CLE pathophysiology, may predispose affected patients to compromised bone perfusion and ischemia, particularly in weight-bearing joints such as the hips and knees. Dermatologic signs, including persistent erythema, ulceration, or livedo reticularis, may reflect underlying vascular dysfunction that extends beyond the skin to subchondral bone, accelerating osteonecrotic processes. The role of autoantibodies, such as antiphospholipid antibodies, and their contribution to thrombotic microangiopathy in CLE further supports this potential mechanistic link. Early recognition of CLE-related vascular changes could guide orthopedic surveillance strategies, enabling timely imaging with MRI to detect early osteonecrosis before irreversible joint damage occurs. Therapeutic interventions for CLE, including corticosteroids and immunosuppressive agents, may inadvertently exacerbate osteonecrosis risk, necessitating careful balancing of treatment efficacy with preservation of joint health. Advances in vascular-targeted therapies and bone-preserving interventions, such as bisphosphonates or regenerative techniques, offer potential avenues for mitigating joint degeneration in this patient population. Understanding the bidirectional relationship between CLE and osteonecrosis provides an opportunity for dermatologists and orthopedists to collaborate on predictive, preventive, and therapeutic strategies that preserve joint function and improve quality of life for affected individuals.展开更多
Objective:To analyze the clinical and laboratory indices of patients with lupus nephritis(LN)of different pathological types and explore the related factors of LN pathological classification,it is helpful to grasp the...Objective:To analyze the clinical and laboratory indices of patients with lupus nephritis(LN)of different pathological types and explore the related factors of LN pathological classification,it is helpful to grasp the timing of renal biopsy.Methods:The clinical manifestations,laboratory parameters and renal pathological types of LN patients in recent 20 years were analyzed retrospectively by SPSS 26.0 software.Results:In this study,the first three pathological types were V,IV,V+IV;latent nephritis was common in type II and V;nephritic syndrome was common in type V;nephrotic syndrome was common in type V+IV;chronic renal insufficiency group was mostly type IV;pathological types were correlated with serum creatinine,C3,albumin and erythrocyte sedimentation rate(r=0.315,P<0.001),and serum creatinine was moderately correlated(r=0.315,P<0.001);AI,CI and SLEDAI scores were significantly different among LN patients of different pathological types.Conclusion:LN is closely related to clinical pathology,clinical manifestations,comprehensive analysis of laboratory indicators and SLEDAI score to make a preliminary prediction of LN pathological type,help to initially assess the severity of pathology,improve the timing of renal biopsy implementation,optimize the timing of treatment.展开更多
Systemic lupus erythematosus(SLE)is characterized by a systemic dysfunction of both the innate and adaptive immune systems,leading to an attack on healthy tissues of the body.During the development of SLE,pathogenic f...Systemic lupus erythematosus(SLE)is characterized by a systemic dysfunction of both the innate and adaptive immune systems,leading to an attack on healthy tissues of the body.During the development of SLE,pathogenic features,such as the formation of autoantibodies against self-nuclear antigens,cause tissue damage including necrosis and fibrosis,with increased expression levels of the typeⅠinterferon-regulated genes.Standard treatments for lupus with immunosuppressants and glucocorticoids are not effective enough but cause side effects.As an alternative,more effective immunotherapies have been developed,including monoclonal and bispecific antibodies that target B cells,T cells,co-stimulatory molecules,cytokines or their receptors,and signaling molecules.Encouraging results have been observed in clinical trials with some of these therapies.Furthermore,a chimeric antigen receptor T cell therapy has emerged as the most effective,safe,and promising treatment option for SLE,as demonstrated by successful pilot studies.Additionally,some emerging evidence suggests that gut microbiota dysbiosis may significantly contribute to the severity of SLE,and the normalization of the gut microbiota through methods such as fecal microbiota transplantation presents new opportunities for effective treatment of SLE.展开更多
Systemic lupus erythematosus(SLE)is a chronic autoimmune disease in which multiple organs are damaged that prevails in fertile women.Currently,glucocorticoids and immunosuppressants are widely used to treat SLE patien...Systemic lupus erythematosus(SLE)is a chronic autoimmune disease in which multiple organs are damaged that prevails in fertile women.Currently,glucocorticoids and immunosuppressants are widely used to treat SLE patients.However,ovarian dysfunction occurs following the use of these drugs in women with SLE.Here,we summarize recent progress in terms of understanding ovarian injury,the effects of drug application and strategies to improve ovarian function in women with SLE.This review could be helpful to precisely cure SLE in women desiring to have offspring.展开更多
BACKGROUND In this study,we retrospectively analysed macrophage infiltration and podocyte injury in three patients with diffuse proliferative lupus nephritis(LN)who un-derwent repeated renal biopsy.CASE SUMMARY Clinic...BACKGROUND In this study,we retrospectively analysed macrophage infiltration and podocyte injury in three patients with diffuse proliferative lupus nephritis(LN)who un-derwent repeated renal biopsy.CASE SUMMARY Clinical data of three diffuse proliferative LN patients with different pathological characteristics(case 1 was LN IV-G(A),case 2 was LN IV-G(A)+V,and case 3 was LN IV-G(A)+thrombotic microangiopathy)were reviewed.All patients underwent repeated renal biopsies 6 mo later,and renal biopsy specimens were studied.Macrophage infiltration was assessed by CD68 expression detected by immunohistochemical staining,and an immunofluorescence assay was used to detect podocin expression to assess podocyte damage.After treatment,Case 1 changed to LN III-(A),Case 2 remained as type V LN lesions,and Case 3,which changed to LN IV-S(A),had the worst prognosis.We observed reduced macro-phage infiltration after therapy.However,two of the patients with active lesions after treatment still showed macrophage infiltration in the renal interstitium.Before treatment,the three patients showed discontinuous expression of podocin.Notably,the integrity of podocin was restored after treatment in Case 1.CONCLUSION It may be possible to reverse podocyte damage and decrease the infiltrating ma-crophages in LN patients through effective treatment.展开更多
AIM:To explore ocular surface manifestations of dry eye disease(DED)and its influencing factors in systemic lupus erythematosus(SLE)patients.METHODS:Ophthalmological examinations were conducted in SLE patients(n=43)an...AIM:To explore ocular surface manifestations of dry eye disease(DED)and its influencing factors in systemic lupus erythematosus(SLE)patients.METHODS:Ophthalmological examinations were conducted in SLE patients(n=43)and controls(n=41),including Ocular Surface Disease Index(OSDI),objective scatter index(OSI),tear meniscus height(TMH),lipid layer thickness(LLT),non-invasive Keratograph tear breakup time(NIKBUT),corneal fluorescein score(CFS),Schirmer I test.DED was diagnosed according to the Tear Film and Ocular Surface Society Dry Eye Workshop II Criteria.SLE patients were further divided into DED group and non-DED group,the disease activity,clinical manifestations and laboratory investigations were compared between the two groups.The disease activity was evaluated by Systemic Lupus Erythematosus Disease Activity Index 2000(SLEDAI-2K).Receiver operative characteristic(ROC)curve and multiplefactor binary logistic regression were performed.RESULTS:SLE patients showed higher OSDI[9.1(2.8-15.9)vs 6.3(2.2-7.5),P=0.035],higher OSI[1.67(1.09-2.60)vs 0.96(0.87-1.60),P=0.001],higher CFS[1(0-2)vs 0(0-1),P=0.001],lower LLT[65(42-100)vs 100(79.5-100),P=0.010],and lower NIKBUT[8.03(4.02-9.73)vs 9.67(5.26-12.71),P=0.030]than controls.The 32.6%of SLE patients had DED,which was higher than 12.2%of healthy controls.DED group showed higher SLEDAI-2K score[9.7±6.1 vs 5.4±3.4,P=0.025],higher anti-cardiolipin antibody(ACL)[8.7(3.5-13.2)vs 3.6(2.0-6.9),P=0.035],and higher proportion of patients with cutaneous eruption[42.9%vs 6.9%,P=0.015]than non-DED group.According to multiple-factor binary logistic regression analysis,the SLEDAI-2K score(OR=1.194,P=0.041)and cutaneous eruption(OR=7.094,P=0.045)could be consider as risk factors for DED in SLE patients.The ROC curve of the combined factors including age,disease duration,SLEDAI-2K score,ACL,and cutaneous eruption was analyzed,with a sensitivity of 0.786,a specificity of 0.793,and an area under curve of 0.820.CONCLUSION:Ocular surface affection is frequent in SLE patients,and patients with high disease activity and cutaneous eruption show increased risk of DED.展开更多
BACKGROUND Systemic lupus erythematosus(SLE)is a chronic inflammatory disease primarily affecting young females.SLE can invade any organ,and various forms of splenic invasion have been reported.Manifestations include ...BACKGROUND Systemic lupus erythematosus(SLE)is a chronic inflammatory disease primarily affecting young females.SLE can invade any organ,and various forms of splenic invasion have been reported.Manifestations include splenomegaly and splenic infarction,rupture,and calcification.The study encountered a rare case of splenic involvement,with nodules of various sizes without calcifications or ruptures.CASE SUMMARY A 15-year-old girl presented with arthralgia,weight loss,fever,increased levels of inflammatory markers,and positive antinuclear antibody test results.The patient was diagnosed with SLE.She was asymptomatic while taking steroids and hydroxychloroquine.Ten months after discharge,the patient developed a fever and abdominal pain.Lupus enteritis was suspected,and abdominopelvic computed tomography(AP-CT)was performed.There were no specific findings in the gastrointestinal tract,but multiple splenic nodules were observed.Infection or hemangioma was considered;however,no specific radiological findings were observed.A biopsy of the spleen was performed to determine the possibility of malignancy.The histological findings of the spleen included extensive periarteriolar necrosis with hematoxylin bodies and numerous karyorrhectic debris.Based on the biopsy results,the patient was diagnosed with an SLE flare-up and was maintained on high-dose steroids and immunosuppressants.CONCLUSION As disease activity increased,multiple nodules in the spleen that were previously unseen were observed using AP-CT and histologically confirmed.Spleen invasion by SLE can appear in multiple nodular forms and patterns.Therefore,physicians should consider these findings when differentiating these nodules from infections and malignancies.展开更多
BACKGROUND Ulcerative colitis(UC)and systemic lupus erythematosus(SLE)are both systemic immunoreactive diseases,and their pathogenesis depends on the interaction between genes and environmental factors.There are no re...BACKGROUND Ulcerative colitis(UC)and systemic lupus erythematosus(SLE)are both systemic immunoreactive diseases,and their pathogenesis depends on the interaction between genes and environmental factors.There are no reports of UC with SLE in China,but six cases of SLE with UC have been reported in China.The combination of these two diseases has distinct effects on the pathogenesis of both diseases.CASE SUMMARY A female patient(30 years old)came to our hospital due to dull umbilical pain,diarrhea and mucous bloody stool in August 2018 and was diagnosed with UC.The symptoms were relieved after oral administration of mesalazine(1 g po tid)or folic acid(5 mg po qd),and the patient were fed a control diet.On June 24,2019,the patient was admitted for treatment due to anemia and tinnitus.During hospitalization,the patient had repeated low-grade fever and a progressively decreased Hb level.Blood tests revealed positive antinuclear antibody test,positive anti-dsDNA antibody,0.24 g/L C3(0.9-1.8 g/L),0.04 g/L C4(0.1-0.4 g/L),32.37 g/L immunoglobulin(8-17 g/L),and 31568.1 mg/24 h total 24-h urine protein(0-150 mg/24 h).The patient was diagnosed with SLE involving the joints,kidneys and blood system.Previously reported cases of SLE were retrieved from PubMed to characterize clinicopathological features and identify prognostic factors for SLE.CONCLUSION The patient was discharged in remission after a series of treatments,such as intravenous methylprednisolone sodium succinate,intravenous human immunoglobulin,cyclophosphamide injection,and plasma exchange.After discharge,the patient took oral prednisone acetate tablets,cyclosporine capsules,hydroxychloroquine sulfate tablets and other treatments for symptoms and was followed up regularly for 1 month,after which the patient's condition continued to improve and stabilize.展开更多
BACKGROUND Systemic lupus erythematosus(SLE)is a heterogeneous autoimmune disorder with varied clinical courses and prognoses,not only did the patients suffer from physical impairment,but also various physical and psy...BACKGROUND Systemic lupus erythematosus(SLE)is a heterogeneous autoimmune disorder with varied clinical courses and prognoses,not only did the patients suffer from physical impairment,but also various physical and psychiatric comorbidities.Growing evidence have suggested that mental disorders in SLE patients,can lead to various adverse consequences.AIM To explored the features and influencing factors of mental health in patients with SLE and clarifying the correlations between mental health and personality characteristics and perceived social support.The results would provide a basis for psychological intervention in patients with SLE.METHODS The clinical data of 168 patients with SLE admitted at the First Affiliated Hospital of Hainan Medical University between June 2020 and June 2022 were collected.Psychological assessment and correlation analysis were conducted using the Symptom Checklist-90(SCL-90)and Perceived Social Support Scale,and the collected data were compared with the national norms in China.The relevant factors influencing mental health were identified by statistical analysis.A general information questionnaire,the Revised Life Orientation Test,and Short-Form 36-Item Health Survey were employed to assess optimism level and quality of life(QoL),respectively.RESULTS Patients with SLE obtained higher scores for the somatization,depression,anxiety,and phobic anxiety subscales than national norms(P<0.05).A correlation was identified between total social support and total SCL-90 score or each subscale(P<0.05).The factors significantly affecting patients’mental health were hormone dosage and disease activity index(DAI)(P<0.05).The average optimism score of patients with SLE was 14.36±4.42,and 30 cases were in the middle and lower levels.A positive correlation was found between optimism level and QoL scores.CONCLUSION Patients with SLE develop psychological disorders at varying degrees,which are significantly influenced by hormone dosage and DAI.Patients’mental health should be closely monitored during clinical diagnosis and treatment and provided adequate support in establishing positive,healthy thinking and behavior patterns and improving their optimism level and QoL.展开更多
Purpose:To explore the status of current global research,trends and hotspots in the field of lupus retinopathy(LR).Methods:Publications related to LR from 2003 to 2022 were extracted from the Web of Science Core Colle...Purpose:To explore the status of current global research,trends and hotspots in the field of lupus retinopathy(LR).Methods:Publications related to LR from 2003 to 2022 were extracted from the Web of Science Core Collection(WOSCC).Citespace 6.2.R4 software was used to analyze the raw data.Bibliometric parameters such as publication quality,countries,authors,international cooperation,and keywords were taken into account.Results:A total of 315 publications were retrieved.The annual research output has increased significantly since 2010,especially since 2017.Marmor MF,Lee BR,and Melles RB contributed the highest number of articles published on LR.The top three publishing countries were the USA,China,and UK.Stanford University,Hanyang University,and Harvard Medical School were the top three producing institutions in the world for LR research.The top ten commonly used keywords include the following:systemic lupus erythematosus,retinopathy,retinal toxicity,antimalarial,hydroxychloroquine,optical coherence tomography,antiphospholipid syndrome,microvascular,optic neuritis,optical coherence tomography angiography.The keywords"optical coherence tomography angiography"and"vessel density"have exploded in recent years.Conclusion:By analyzing the current body of LR literature,specific global trends and hotspots for LR research were identified,presenting valuable information to track cutting-edge progress and for future cooperation between various authors and institutions.展开更多
文摘BACKGROUND Proliferative lupus nephritis(PLN)is the most severe form of lupus nephritis(LN).There are limited data available on renal outcomes of PLN from developing countries.AIM To determine the clinicopathological characteristics and long-term outcomes in terms of remission,requirement of kidney replacement therapy(KRT),and patient survival.METHODS A retrospective analysis was conducted on biopsy-proven focal or diffuse PLN cases diagnosed between 1998 and 2019 at the Sindh Institute of Urology and Transplantation and followed up at the renal clinic for a minimum of 5 years.All patients were induced with a combination of intravenous cyclophosphamide and corticosteroids for 6 months,followed by maintenance treatment with azathioprine(AZA)or mycophenolate mofetil(MMF).Data were analyzed using Statistical Package for the Social Sciences,version 22.0.P≤0.05 was considered statistically significant.RESULTS The mean age at the onset of systemic lupus erythematosus was 24.12 years±8.89 years,and at LN onset,26.63 years±8.61 years.There was a female predominance of 184(88.9%)cases.Among baseline characteristics,reduced estimated glomerular filtration rate,presence of hypertension,requirement of KRT,and underlying renal histology(International Society of Nephrology/Renal Pathology Society class IV than class III)were significantly associated with end-stage kidney disease(ESKD)and mortality.The renal outcomes were negatively correlated with age,duration of symptoms,and 24-hour urinary protein excretion.The overall remission rate was 89.8%at the end of induction therapy.At 5 years,141(68.11%)patients were in complete and partial remission(94[45.4%]and 47[22.7%],respectively).In total,19(9.2%)patients required KRT on presentation,and at 5 years,38(18.4%)patients developed ESKD,and 28(13.5%)patients died.Thirty-four(16.4%)patients had a renal relapse,more with AZA than MMF(30[88.2%]vs 4[11.76%],respectively;P=0.04).Renal survival at 6 months was 89.8%,while at 5 years,it was 68.11%,showing a significant improvement in patients who did not need KRT at the time of presentation(P<0.0001).CONCLUSION Baseline renal functions,requirement of KRT,and diffuse proliferative disease were the most relevant prognostic factors for kidney survival among this cohort.Short-term renal outcomes were good.Long-term outcomes were poorer with AZA-based maintenance therapy than with MMF,with more ESKD and mortality.
基金funded by National Natural Science Foundation of China to Ping Yang with Grant number No.82202600by Nanjing Drum Tower Hospital to Ping Yang with Grant number No.2024-LCYJ-MS-11then to Shou-bin Zhan with Grant number No.2023-JCYJ-QP-25.
文摘Objective This study aims to investigate the exosome-derived metabolomics profiles in systemic lupus erythematosus(SLE),identify differential metabolites,and analyze their potential as diagnostic markers for SLE and lupus nephritis(LN).Methods Totally,91 participants were enrolled between February 2023 and January 2024 including 58 SLE patients[30 with nonrenal-SLE and 28 with Lupus nephritis(LN)]and 33 healthy controls(HC).Ultracentrifugation was used to isolate serum exosomes,which were analyzed for their metabolic profiles using liquid chromatography–tandem mass spectrometry(LC–MS/MS).Endogenous metabolites were identified via public metabolite databases.Random Forest,Lasso regression and Support Vector Machine Recursive Feature Elimination(SVM-RFE)algorithms were employed to screen key metabolites,and a prediction model was constructed for SLE diagnosis and LN discrimination.ROC curves were constructed to determine the potential of these differential exosome-derived metabolites for the diagnosis of SLE.Furthermore,Spearman’s correlation was employed to evaluate the potential links between exosome-derived metabolites and the clinical parameters which reflect disease progression.Results A total of 586 endogenous serum exosome-derived metabolites showed differential expression,with 225 exosome-derived metabolites significantly upregulated,88 downregulated and 273 exhibiting no notable changes in the HC and SLE groups.Machine learning algorithms revealed three differential metabolites:Pro-Asn-Gln-Met-Ser,C24:1 sphingolipid,and protoporphyrin IX,which exhibited AUC values of 0.998,0.992 and 0.969 respectively,for distinguishing between the SLE and HC groups,with a combined AUC of 1.0.In distinguishing between the LN and SLE groups,the AUC values for these metabolites were 0.920,0.893 and 0.865,respectively,with a combined AUC of 0.931,demonstrating excellent diagnostic performance.Spearman correlation analysis revealed that Pro-Asn-Gln-Met-Ser and protoporphyrin IX were positively correlated with the SLE Disease Activity Index(SLEDAI)scores,urinary protein/creatinine ratio(ACR)and urinary protein levels,while C24:1 sphingolipid exhibited a negative correlation.Conclusions This study provides the first comprehensive characterization of the exosome-derived metabolites in SLE and established a promising prediction model for SLE and LN discrimination.The correlation between exosome-derived metabolites and key clinical parameters strongly indicated their potential role in SLE pathological progression.
基金Supported by STI2030-Major Projects,No.2021ZD0202001National Natural Science Foundation of China,No.T2341003Capital Funds for Health Improvement and Research,No.CFH 2022-2-4012.
文摘BACKGROUND Not all neuropsychiatric(NP)manifestations in patients with systemic lupus erythematosus(SLE)are secondary to lupus.The clarification of the cause of NP symptoms influences therapeutic strategies for SLE.AIM To understand the attribution of psychiatric manifestations in a cohort of Chinese patients with SLE.METHODS This retrospective single-center study analyzed 160 inpatient medical records.Clinical diagnosis,which is considered the gold standard,was used to divide the subjects into a psychiatric SLE(PSLE)group(G1)and a secondary psychiatric symptoms group(G2).Clinical features were compared between these two groups.The sensitivity and specificity of the Italian attribution model were explored.RESULTS A total of 171 psychiatric syndromes were recorded in 138 patients,including 87 cases of acute confusional state,40 cases of cognitive dysfunction,18 cases of psychosis,and 13 cases each of depressive disorder and mania or hypomania.A total of 141(82.5%)syndromes were attributed to SLE.In contrast to G2 patients,G1 patients had higher SLE Disease Activity Index-2000 scores(21 vs 12,P=0.001),a lower prevalence of anti-beta-2-glycoprotein 1 antibodies(8.6%vs 25.9%,P=0.036),and a higher prevalence of anti-ribosomal ribonucleoprotein particle(rRNP)antibodies(39.0%vs 22.2%,P=0.045).The Italian attribution model exhibited a sensitivity of 95.0%and a specificity of 70.0%when the threshold value was set at 7.CONCLUSION Patients with PSLE exhibited increased disease activity.There is a correlation between PSLE and anti-rRNP antibodies.The Italian model effectively assesses multiple psychiatric manifestations in Chinese SLE patients who present with NP symptoms.
基金Supported by Natural Science Foundation of Zhejiang Province,No.LY23H050005Zhejiang Medical Technology Project,No.2020KY439,No.2022RC009,No.2024KY645,and No.2024KY697.
文摘Lupus nephritis(LN)is one of the most common and serious complications of systemic lupus erythematosus,which can lead to end-stage renal disease,and is an important cause of death in patients with systemic lupus erythematosus.Treatment options include glucocorticoids,immunosuppressive agents and the addition of biologics.Recently,the therapeutic role of mesenchymal stem cells(MSCs)in LN has received extensive attention worldwide.MSCs can suppress autoimmunity,alleviate proteinuria and restore renal function by modulating the functions of various immune cells and reducing the secretion of inflammatory cytokines.Several clinical trials have investigated MSC treatment in LN with promising but sometimes inconsistent outcomes.This review summarizes the sources of MSCs and mechanisms in immunoregulation.Furthermore,it examines clinical trials evaluating the efficacy,safety,and limitations of MSC therapy in LN.By highlighting advances and ongoing challenges,this review underscores the potential of MSCs for LN treatment.More large-scale randomized controlled trials are needed to support the effectiveness of this therapy and pave the way for personalized and combinatorial therapeutic approaches.
基金Supported by STI2030-Major Projects,No.2021ZD0202001Capital Funds for Health Improvement and Research,No.CFH 2022-2-4012.
文摘BACKGROUND Systemic lupus erythematosus(SLE)can affect multiple organs or systems.The involvement of the central nervous system can result in the manifestation of epilepsy,an acute confusional state,and other rare neuropsychiatric presentations,such as catatonia.CASE SUMMARY We present a case of an adolescent male patient with first-onset SLE who presented with neuropsychiatric symptoms including epilepsy and delirium.The initial utilization of olanzapine to alleviate symptoms of agitation precipitated the emergence of catatonia,which was mitigated by discontinuing olanzapine and supplementing with lorazepam.In this case,whether the catatonia was secondary to the utilization of antipsychotics or to an organic disease is a question that warrants differential diagnosis.CONCLUSION Multidisciplinary collaborative management is the cornerstone for the successful management of severe cases of SLE.
文摘Objective To review and synthesize preclinical and clinical evidence regarding traditional Chinese medicine(TCM)formulations and bioactive herbal compounds in lupus nephritis(LN),and to identify direction and research priorities for integrating TCM with professional care.Methods A narrative literature review was conducted by searching Scopus,PubMed,Web of Science,and Google Scholar for articles published between January 1,2011 and March 31,2024.Search terms combined controlled vocabulary[e.g.,medical subject headings(MeSH)]and free-text words including lupus nephritis,traditional Chinese medicine,Chinese herbal medicine,formulation,and names of specific herbs[Leigongteng(Tripterygii Wilfordii Radix et Rhizoma),Baishao(Paeoniae Radix Alba),and Yinghao(Artemisiae Annuae Herba)].Both randomized controlled trials and observational studies were included,along with mechanistic preclinical studies and pharmacologic investigations.Inclusion criteria were studies that reported renal outcomes(proteinuria and estimated glomerular filtration rate),immunemodulatory mechanisms,or safety and herb-drug interaction data.Studies without primary data,case reports,or those lacking relevance to LN were excluded.References of key articles were manually screened to identify additional eligible studies.Results TCM formulas[e.g.,Liuwei Dihuang Pills(六味地黄丸),Zhibai Dihuang Pills(知柏地黄丸),and Huanglian Jiedu Decoction(黄连解毒汤)]and herbal medicines[e.g.,extracts from Leigongteng(Tripterygii Wilfordii Radix et Rhizoma),Baishao(Paeoniae Radix Alba),and Yinghao(Artemisiae Annuae Herba)]were commonly used in the above studies.TCM formulations and their constituent compounds showed multi-modal mechanisms relevant to LN pathogenesis,encompassing immunomodulation(reduction of autoreactive B/T cell activity,regulatory T cell enhancement),inhibition of pro-inflammatory signaling pathways nuclear factor kappa-light-chain-enhancer of activated B cells(NF-κB),mitogen-activated protein kinase(MAPK),nucleotide-binding oligomerization domain(NOD),leucine-rich repeat(LRR)and pyrin domain-containing protein 3(NLRP3 inflammasome),anti-fibrotic and antioxidant effects,and direct renal-protective properties.In many studies,these indicators can reduce proteinuria and improve renal function.Clinical data,while promising,are heterogeneous in design,sample size,endpoints,and TCM formulation standardization.Safety concerns(notably with Tripterygium preparations)and potential herb-drug interactions with immunosuppressants remained important considerations.Conclusion TCM offers biologically plausible and multi-targeted adjuvant strategies for LN that may enhance therapeutic efficacy and reduce toxicity when combined with modern therapies.To translate these promises into clinical practice,future work should prioritize the standardization of TCM preparations,randomized controlled trials with clinically meaningful renal endpoints,elucidation of molecular mechanisms,and systematic evaluation of pharmacokinetic and safety interactions.Such integrative research will be essential to define the TCM’s role in evidence-based,patient-centered LN management.
文摘AIM:To summarize and quantitatively evaluate vasculature alteration of foveal zone in systemic lupus erythematosus(SLE)patients by secondary literature analysis.METHODS:A systematic search of PubMed,Embase,Web of Science,Cochrane Library,CBM,CNKI WanFang Data and VIP was conducted.Studies were about retinal vessel density in SLE patients from January 2000 to April 2023 and valid data were extracted.The Joanna Briggs Institute(JBI)critical appraisal checklist was used to evaluate the cross-sectional studies and prospective studies.The measurement data for combined effect size were weighted mean difference(WMD)and 95%confidence interval(CI).The heterogeneity was evaluated by I2 test.The fixed-effect model was adopted when P>0.1 or I2<50%,and random-effect model was adopted in the contrary.Subgroup and sensitivity analysis were utilized to analyze the sources of heterogeneity.The publication bias was evaluated by Egger tests and funnel plots.RESULTS:A total of 14 studies with 445 subjects and 441 healthy controls from 9 countries were enrolled and 11 studies were included in Meta-analysis.The JBI scores of studies were no less than 14 points.The Metaanalysis results indicated that mean parafoveal superficial vessel density(SVD;WMD=-1.22,95%CI:-1.67,-0.76),mean perifoveal SVD(WMD=-1.42,95%CI:-1.95,-0.89),mean whole SVD(WMD=-1.66,95%CI:-2.53,-0.79),mean parafoveal deep vessel density(WMD=-1.67,95%CI:-2.75,-0.59)and mean whole deep vessel density(WMD=-4.09,95%CI:-7.67,-0.52)was significantly lower than the control,while mean foveal SVD(WMD=-1.71,95%CI:-4.65,1.24),mean foveal avascular zone(FAZ)area(WMD=0.04,95%CI:-0.01,0.09)and mean acircularity index(AI;WMD=0.00,95%CI:-0.02,0.02)were not different between SLE patients and controls.Subgroup analysis indicated that the heterogeneity in SVD was partially due to the scanning area.Ocellus or binoculus data contributed partially to the heterogeneity in parafoveal deep vessel density and FAZ area.Sensitivity analysis indicated that the results were robust after changing the analysis model except for foveal SVD and FAZ area.There was no bias in included studies except whole SVD.CONCLUSION:Parafoveal superficial and deep vessel density are significantly lower in SLE patients while FAZ area and AI are not different between SLE patients and the control.
文摘Pediatric lupus nephritis(LN)is a challenging and severe condition in pediatrics.Traditional Chinese medicine(TCM)has shown significant advantages in improving immune disorders,reducing recurrence rates,and mitigating the toxic side effects of Western medications.However,it faces challenges such as the lack of a unified TCM syndrome differentiation system,insufficient standardization of dynamic syndrome differentiation,an incomplete efficacy evaluation system,and a lack of precise intervention methods.This study focuses on the clinical advantages of TCM.On 1 September 2024,the 35th Clinical Advantage Disease Series Salon was held in Zhengzhou,discussing the advantages of TCM and integrated Chinese-Western medicine in treating pediatric LN.Experts in TCM and integrated Chinese-Western medicine,along with interdisciplinary researchers,conducted extensive and in-depth discussions.They proposed specific recommendations for TCM and integrated Chinese-Western medicine in treating pediatric LN and reached a consensus.Based on this,the study analyzes the challenges in treating pediatric LN from the perspective of its development patterns,and summarizes three key areas and six research directions to highlight the advantages of TCM and integrated Chinese-Western medicine in treating pediatric LN.It focuses on three key areas:The construction of a TCM system for pediatric LN,the prevention and treatment of complications,and chronic disease management.And it proposes six research directions:(1)Constructing a syndrome differentiation system for pediatric LN;(2)Formulating TCM and integrated Chinese-Western medicine guidelines for pediatric LN;(3)Researching the mechanisms of enhancing efficacy and reducing toxicity in integrated Chinese-Western medicine for pediatric LN;(4)Preventing and treating complications in pediatric LN;(5)Developing and researching TCM regimens for preventing and treating the recurrence of pediatric LN;(6)Strategies for the full-cycle chronic disease management of pediatric LN.Finally,the study summarizes and generalizes the technological layout and research directions for pediatric LN.Therefore,based on the series of salons on traditional Chinese medicine advantages for children LN diseases,this paper puts forward a research paradigm of scientific and technological breakthroughs for children LN,in order to provide reference for the construction and research direction of children LN diagnosis and treatment system with traditional Chinese medicine characteristics.
文摘AIM:To evaluate the choroidopathy in patients with systemic lupus erythematosus(SLE)using enhanced depth imaging spectral domain optical coherence tomography(EDI SD-OCT)and optical coherence tomography angiography(OCTA).METHODS:A total of 74 patients with SLE and 40 healthy volunteers were included in this cross-sectional study.SLE patients were further divided into three subgroups based on clinical and blood biochemistry findings.Ocular parameters obtained on ophthalmologic examination and optical imaging(EDI SD-OCT and OCTA)included the best corrected distance visual acuity(logMAR CDVA),subfoveal choroidal thickness(SCT),choroidal vascularity index(CVI)and vessel density(VD)of superficial capillary plexus(SCP)and deep capillary plexus(DCP).RESULTS:SLE patients had significantly lower values for CVI and VD of DCP(DVD)than control subjects.Amongst SLE patients,gender and chloroquine dose were found to be independent determinants of CVI while age predicted SCT.Steroid dose was a significant predictor for foveal VD of SCP(SVD),chloroquine dose for parafoveal SVD,gender for total DVD,and gender and steroid dose for perifoveal DVD.No correlation of logMAR CDVA and SCT was noted between SLE patients and control subjects.No correlation of SCT was noted with disease duration,Systemic Lupus Erythematosus Disease Activity Index(SLEDAI)score,hydroxychloroquine(HCQ)dose or steroid dose.No correlation of CVI was noted with patient age,disease duration,SLEDAI score,HCQ dose or steroid dose.No significant difference was noted between SLE subgroups in terms of any of the ocular parameters studied.CONCLUSION:The findings reveal the presence of ocular findings suggestive of early onset choroidopathy on EDI SD-OCT and OCTA in SLE patients,in the absence of ocular manifestations or active disease.
文摘Pregnancy in women with lupus,particularly those with lupus nephritis(LN),carries an increased risk of adverse outcomes.Women with active LN at the time of conception are at a high risk of poor maternal and fetal outcomes.Recent studies indicate that even in the presence of quiescent disease,factors such as hypertension and positive lupus anticoagulant are predictors of worse pregnancy outcomes.Consequently,pre-conception evaluation is essential to ensure that pursuing pregnancy is safe and timely,and to facilitate proper planning for optimizing medical regimens,discontinuing teratogenic agents,and treating active disease.Additionally,pre-existing LN is associated with higher rates of preeclampsia and hemolysis,elevated liver enzymes,and low platelet count syndrome.Women with lupus and prior LN can have successful pregnancies,but a multidisciplinary approach with close monitoring is essential for optimal outcomes.By systematically reviewing the available evidence,this narrative review aims to provide a comprehensive update on the complex interaction between LN and pregnancy,offering insights to guide clinical practice and future research in this field.
文摘The intersection of cutaneous lupus erythematosus (CLE) and osteonecrosis highlights a complex relationship between dermatologic and orthopedic pathology, underscoring the systemic nature of autoimmune disease. Osteonecrosis, characterized by ischemic bone death and subsequent joint degeneration, is a known complication in systemic lupus erythematosus (SLE), but emerging evidence suggests that CLE manifestations may serve as early indicators or contributory factors in its development. Chronic inflammation and microvascular injury, central to CLE pathophysiology, may predispose affected patients to compromised bone perfusion and ischemia, particularly in weight-bearing joints such as the hips and knees. Dermatologic signs, including persistent erythema, ulceration, or livedo reticularis, may reflect underlying vascular dysfunction that extends beyond the skin to subchondral bone, accelerating osteonecrotic processes. The role of autoantibodies, such as antiphospholipid antibodies, and their contribution to thrombotic microangiopathy in CLE further supports this potential mechanistic link. Early recognition of CLE-related vascular changes could guide orthopedic surveillance strategies, enabling timely imaging with MRI to detect early osteonecrosis before irreversible joint damage occurs. Therapeutic interventions for CLE, including corticosteroids and immunosuppressive agents, may inadvertently exacerbate osteonecrosis risk, necessitating careful balancing of treatment efficacy with preservation of joint health. Advances in vascular-targeted therapies and bone-preserving interventions, such as bisphosphonates or regenerative techniques, offer potential avenues for mitigating joint degeneration in this patient population. Understanding the bidirectional relationship between CLE and osteonecrosis provides an opportunity for dermatologists and orthopedists to collaborate on predictive, preventive, and therapeutic strategies that preserve joint function and improve quality of life for affected individuals.
基金Shandong Province Medical and Health Science and Technology Development Plan Project(No.202203051068).
文摘Objective:To analyze the clinical and laboratory indices of patients with lupus nephritis(LN)of different pathological types and explore the related factors of LN pathological classification,it is helpful to grasp the timing of renal biopsy.Methods:The clinical manifestations,laboratory parameters and renal pathological types of LN patients in recent 20 years were analyzed retrospectively by SPSS 26.0 software.Results:In this study,the first three pathological types were V,IV,V+IV;latent nephritis was common in type II and V;nephritic syndrome was common in type V;nephrotic syndrome was common in type V+IV;chronic renal insufficiency group was mostly type IV;pathological types were correlated with serum creatinine,C3,albumin and erythrocyte sedimentation rate(r=0.315,P<0.001),and serum creatinine was moderately correlated(r=0.315,P<0.001);AI,CI and SLEDAI scores were significantly different among LN patients of different pathological types.Conclusion:LN is closely related to clinical pathology,clinical manifestations,comprehensive analysis of laboratory indicators and SLEDAI score to make a preliminary prediction of LN pathological type,help to initially assess the severity of pathology,improve the timing of renal biopsy implementation,optimize the timing of treatment.
基金funded by the Russian Science Foundation Grant No.21-74-10154 to A.K.
文摘Systemic lupus erythematosus(SLE)is characterized by a systemic dysfunction of both the innate and adaptive immune systems,leading to an attack on healthy tissues of the body.During the development of SLE,pathogenic features,such as the formation of autoantibodies against self-nuclear antigens,cause tissue damage including necrosis and fibrosis,with increased expression levels of the typeⅠinterferon-regulated genes.Standard treatments for lupus with immunosuppressants and glucocorticoids are not effective enough but cause side effects.As an alternative,more effective immunotherapies have been developed,including monoclonal and bispecific antibodies that target B cells,T cells,co-stimulatory molecules,cytokines or their receptors,and signaling molecules.Encouraging results have been observed in clinical trials with some of these therapies.Furthermore,a chimeric antigen receptor T cell therapy has emerged as the most effective,safe,and promising treatment option for SLE,as demonstrated by successful pilot studies.Additionally,some emerging evidence suggests that gut microbiota dysbiosis may significantly contribute to the severity of SLE,and the normalization of the gut microbiota through methods such as fecal microbiota transplantation presents new opportunities for effective treatment of SLE.
基金Supported by the National Natural Science Foundation of China,No.82271843Key Project supported by Medical Science and Technology Development Foundation,Nanjing Department of Health,No.ZKX20019.
文摘Systemic lupus erythematosus(SLE)is a chronic autoimmune disease in which multiple organs are damaged that prevails in fertile women.Currently,glucocorticoids and immunosuppressants are widely used to treat SLE patients.However,ovarian dysfunction occurs following the use of these drugs in women with SLE.Here,we summarize recent progress in terms of understanding ovarian injury,the effects of drug application and strategies to improve ovarian function in women with SLE.This review could be helpful to precisely cure SLE in women desiring to have offspring.
基金Supported by National Natural Science Foundation of China,No.81960136the Science and Technology Department of Yunnan Province,No.202101AT070243.
文摘BACKGROUND In this study,we retrospectively analysed macrophage infiltration and podocyte injury in three patients with diffuse proliferative lupus nephritis(LN)who un-derwent repeated renal biopsy.CASE SUMMARY Clinical data of three diffuse proliferative LN patients with different pathological characteristics(case 1 was LN IV-G(A),case 2 was LN IV-G(A)+V,and case 3 was LN IV-G(A)+thrombotic microangiopathy)were reviewed.All patients underwent repeated renal biopsies 6 mo later,and renal biopsy specimens were studied.Macrophage infiltration was assessed by CD68 expression detected by immunohistochemical staining,and an immunofluorescence assay was used to detect podocin expression to assess podocyte damage.After treatment,Case 1 changed to LN III-(A),Case 2 remained as type V LN lesions,and Case 3,which changed to LN IV-S(A),had the worst prognosis.We observed reduced macro-phage infiltration after therapy.However,two of the patients with active lesions after treatment still showed macrophage infiltration in the renal interstitium.Before treatment,the three patients showed discontinuous expression of podocin.Notably,the integrity of podocin was restored after treatment in Case 1.CONCLUSION It may be possible to reverse podocyte damage and decrease the infiltrating ma-crophages in LN patients through effective treatment.
文摘AIM:To explore ocular surface manifestations of dry eye disease(DED)and its influencing factors in systemic lupus erythematosus(SLE)patients.METHODS:Ophthalmological examinations were conducted in SLE patients(n=43)and controls(n=41),including Ocular Surface Disease Index(OSDI),objective scatter index(OSI),tear meniscus height(TMH),lipid layer thickness(LLT),non-invasive Keratograph tear breakup time(NIKBUT),corneal fluorescein score(CFS),Schirmer I test.DED was diagnosed according to the Tear Film and Ocular Surface Society Dry Eye Workshop II Criteria.SLE patients were further divided into DED group and non-DED group,the disease activity,clinical manifestations and laboratory investigations were compared between the two groups.The disease activity was evaluated by Systemic Lupus Erythematosus Disease Activity Index 2000(SLEDAI-2K).Receiver operative characteristic(ROC)curve and multiplefactor binary logistic regression were performed.RESULTS:SLE patients showed higher OSDI[9.1(2.8-15.9)vs 6.3(2.2-7.5),P=0.035],higher OSI[1.67(1.09-2.60)vs 0.96(0.87-1.60),P=0.001],higher CFS[1(0-2)vs 0(0-1),P=0.001],lower LLT[65(42-100)vs 100(79.5-100),P=0.010],and lower NIKBUT[8.03(4.02-9.73)vs 9.67(5.26-12.71),P=0.030]than controls.The 32.6%of SLE patients had DED,which was higher than 12.2%of healthy controls.DED group showed higher SLEDAI-2K score[9.7±6.1 vs 5.4±3.4,P=0.025],higher anti-cardiolipin antibody(ACL)[8.7(3.5-13.2)vs 3.6(2.0-6.9),P=0.035],and higher proportion of patients with cutaneous eruption[42.9%vs 6.9%,P=0.015]than non-DED group.According to multiple-factor binary logistic regression analysis,the SLEDAI-2K score(OR=1.194,P=0.041)and cutaneous eruption(OR=7.094,P=0.045)could be consider as risk factors for DED in SLE patients.The ROC curve of the combined factors including age,disease duration,SLEDAI-2K score,ACL,and cutaneous eruption was analyzed,with a sensitivity of 0.786,a specificity of 0.793,and an area under curve of 0.820.CONCLUSION:Ocular surface affection is frequent in SLE patients,and patients with high disease activity and cutaneous eruption show increased risk of DED.
文摘BACKGROUND Systemic lupus erythematosus(SLE)is a chronic inflammatory disease primarily affecting young females.SLE can invade any organ,and various forms of splenic invasion have been reported.Manifestations include splenomegaly and splenic infarction,rupture,and calcification.The study encountered a rare case of splenic involvement,with nodules of various sizes without calcifications or ruptures.CASE SUMMARY A 15-year-old girl presented with arthralgia,weight loss,fever,increased levels of inflammatory markers,and positive antinuclear antibody test results.The patient was diagnosed with SLE.She was asymptomatic while taking steroids and hydroxychloroquine.Ten months after discharge,the patient developed a fever and abdominal pain.Lupus enteritis was suspected,and abdominopelvic computed tomography(AP-CT)was performed.There were no specific findings in the gastrointestinal tract,but multiple splenic nodules were observed.Infection or hemangioma was considered;however,no specific radiological findings were observed.A biopsy of the spleen was performed to determine the possibility of malignancy.The histological findings of the spleen included extensive periarteriolar necrosis with hematoxylin bodies and numerous karyorrhectic debris.Based on the biopsy results,the patient was diagnosed with an SLE flare-up and was maintained on high-dose steroids and immunosuppressants.CONCLUSION As disease activity increased,multiple nodules in the spleen that were previously unseen were observed using AP-CT and histologically confirmed.Spleen invasion by SLE can appear in multiple nodular forms and patterns.Therefore,physicians should consider these findings when differentiating these nodules from infections and malignancies.
文摘BACKGROUND Ulcerative colitis(UC)and systemic lupus erythematosus(SLE)are both systemic immunoreactive diseases,and their pathogenesis depends on the interaction between genes and environmental factors.There are no reports of UC with SLE in China,but six cases of SLE with UC have been reported in China.The combination of these two diseases has distinct effects on the pathogenesis of both diseases.CASE SUMMARY A female patient(30 years old)came to our hospital due to dull umbilical pain,diarrhea and mucous bloody stool in August 2018 and was diagnosed with UC.The symptoms were relieved after oral administration of mesalazine(1 g po tid)or folic acid(5 mg po qd),and the patient were fed a control diet.On June 24,2019,the patient was admitted for treatment due to anemia and tinnitus.During hospitalization,the patient had repeated low-grade fever and a progressively decreased Hb level.Blood tests revealed positive antinuclear antibody test,positive anti-dsDNA antibody,0.24 g/L C3(0.9-1.8 g/L),0.04 g/L C4(0.1-0.4 g/L),32.37 g/L immunoglobulin(8-17 g/L),and 31568.1 mg/24 h total 24-h urine protein(0-150 mg/24 h).The patient was diagnosed with SLE involving the joints,kidneys and blood system.Previously reported cases of SLE were retrieved from PubMed to characterize clinicopathological features and identify prognostic factors for SLE.CONCLUSION The patient was discharged in remission after a series of treatments,such as intravenous methylprednisolone sodium succinate,intravenous human immunoglobulin,cyclophosphamide injection,and plasma exchange.After discharge,the patient took oral prednisone acetate tablets,cyclosporine capsules,hydroxychloroquine sulfate tablets and other treatments for symptoms and was followed up regularly for 1 month,after which the patient's condition continued to improve and stabilize.
基金Supported by National Natural Science Foundation of China,No.81760840 and No.82160874Natural Science Foundation of Hainan Province,No.2019RC206.
文摘BACKGROUND Systemic lupus erythematosus(SLE)is a heterogeneous autoimmune disorder with varied clinical courses and prognoses,not only did the patients suffer from physical impairment,but also various physical and psychiatric comorbidities.Growing evidence have suggested that mental disorders in SLE patients,can lead to various adverse consequences.AIM To explored the features and influencing factors of mental health in patients with SLE and clarifying the correlations between mental health and personality characteristics and perceived social support.The results would provide a basis for psychological intervention in patients with SLE.METHODS The clinical data of 168 patients with SLE admitted at the First Affiliated Hospital of Hainan Medical University between June 2020 and June 2022 were collected.Psychological assessment and correlation analysis were conducted using the Symptom Checklist-90(SCL-90)and Perceived Social Support Scale,and the collected data were compared with the national norms in China.The relevant factors influencing mental health were identified by statistical analysis.A general information questionnaire,the Revised Life Orientation Test,and Short-Form 36-Item Health Survey were employed to assess optimism level and quality of life(QoL),respectively.RESULTS Patients with SLE obtained higher scores for the somatization,depression,anxiety,and phobic anxiety subscales than national norms(P<0.05).A correlation was identified between total social support and total SCL-90 score or each subscale(P<0.05).The factors significantly affecting patients’mental health were hormone dosage and disease activity index(DAI)(P<0.05).The average optimism score of patients with SLE was 14.36±4.42,and 30 cases were in the middle and lower levels.A positive correlation was found between optimism level and QoL scores.CONCLUSION Patients with SLE develop psychological disorders at varying degrees,which are significantly influenced by hormone dosage and DAI.Patients’mental health should be closely monitored during clinical diagnosis and treatment and provided adequate support in establishing positive,healthy thinking and behavior patterns and improving their optimism level and QoL.
基金supported by Natural Science Foundation Project of Guangdong Province(2020A1515010276)Guangzhou Science and Technology Project(2024A03J0207)Science and Technology Project of Quanzhou City(2022N030S).
文摘Purpose:To explore the status of current global research,trends and hotspots in the field of lupus retinopathy(LR).Methods:Publications related to LR from 2003 to 2022 were extracted from the Web of Science Core Collection(WOSCC).Citespace 6.2.R4 software was used to analyze the raw data.Bibliometric parameters such as publication quality,countries,authors,international cooperation,and keywords were taken into account.Results:A total of 315 publications were retrieved.The annual research output has increased significantly since 2010,especially since 2017.Marmor MF,Lee BR,and Melles RB contributed the highest number of articles published on LR.The top three publishing countries were the USA,China,and UK.Stanford University,Hanyang University,and Harvard Medical School were the top three producing institutions in the world for LR research.The top ten commonly used keywords include the following:systemic lupus erythematosus,retinopathy,retinal toxicity,antimalarial,hydroxychloroquine,optical coherence tomography,antiphospholipid syndrome,microvascular,optic neuritis,optical coherence tomography angiography.The keywords"optical coherence tomography angiography"and"vessel density"have exploded in recent years.Conclusion:By analyzing the current body of LR literature,specific global trends and hotspots for LR research were identified,presenting valuable information to track cutting-edge progress and for future cooperation between various authors and institutions.
