systemic lupus erythematosus
Introduction
Introduction to systemic lupus erythematosus Systemic lupus erythematosus (SLE) is an autoimmune inflammatory connective tissue disease that affects multiple organs in young women. Early, mild, and atypical cases are increasing. Some critically ill patients (except those with diffuse proliferative glomerulonephritis) can sometimes relieve themselves. Some patients have a "transient" episode, and the disease can completely disappear after a short period of several months. basic knowledge The proportion of illness: 0.002%-0.005% Susceptible people: more than 20 to 40 years old Mode of infection: non-infectious Complications: mental retardation mental disorder dementia leukemia lymphoma AIDS systemic lupus erythematosus
Cause
Causes of systemic lupus erythematosus
The etiology of the disease has not yet been affirmed, and a large number of studies have shown that genetic, endocrine, infection, immune abnormalities and some environmental factors are related to the pathogenesis of this disease.
In the genetic quality, environmental factors, estrogen levels and other factors interact, resulting in the reduction of T lymphocytes, T inhibition of cell function, B cells hyperproliferation, the production of a large number of autoantibodies, and the corresponding autoantigens in vivo to form a corresponding The immune complex, deposited in the skin, joints, small blood vessels, glomeruli and other parts, with the participation of complement, causing acute and chronic inflammation and tissue necrosis (such as lupus nephritis), or antibodies directly interact with tissue cell antigens, causing cells Destruction (eg, specific antigens of red blood cells, lymphocytes, and platelet walls bind to the corresponding autoantibodies, causing hemolytic anemia, lymphopenia, and thrombocytopenia, respectively), resulting in multiple systemic damage to the body.
Prevention
Systemic lupus erythematosus prevention
Population prevention
(1) Strengthening census and publicity: Strengthening the investigation of epidemiology of autoimmune diseases, establishing specialist counseling clinics, organizing patient associations, and discovering patients in time.
(2) Improve the level of diagnosis and treatment of medical staff: With the development of immunology and other basic medicines, the research on autoimmune diseases has also developed accordingly. Therefore, strengthening theoretical study and continuously improving the level of diagnosis and treatment of such diseases by medical personnel is Early detection and important measures for timely treatment.
(3) Laboratory testing techniques for developing and gradually popularizing autoimmune diseases: The histopathological changes of some autoimmune diseases are already obvious, but there is no typical clinical manifestation, so assistance with immunoassay techniques is needed, including detection of certain Autoimmune diseases have antibodies of particular diagnostic significance.
Personal prevention
(1) Primary prevention: Try to avoid inducing immune response factors, which is the key to preventing autoimmune diseases.
1 Maintain optimism: Modern immunological studies have shown that the body's immune function is also regulated by neurological and endocrine factors, so maintaining an optimistic mood is important to maintain the body's normal immune regulation.
2 adhere to exercise: physical exercise or participate in appropriate physical labor is an important way to enhance physical fitness and improve the body's ability to resist disease. Physical exercise can enhance the body's adaptability to external environmental changes, reduce the chance of disease, such as doing exercises, practicing Qigong, Take a walk, play Tai Chi, warm water or warm water bath.
3 Combination of work and rest: Traditional Chinese medicine has always advocated that there is a diet and a regular life. It is a major measure to keep fit and exercise. The rules of life, moderation and diet, moderate work and rest, can maintain energy and strength, avoid external causes. Invasion of disease factors.
4 to avoid predisposing factors: for example, when the summer comes, direct sunlight, it is easy to aggravate the skin damage of SLE patients, and even cause fluctuations in the whole body condition. Exposure and fatigue often make the condition change drastically, brain and heart damage occur, and can be applied when needed. Anti-radiation drugs such as 3% quinine ointment, compound titanium dioxide ointment, 10% ammonia benzoic acid ointment, etc., other exposures such as cold, X-ray, etc., can also cause the disease to intensify, can not be ignored.
5 prevention of infection: prevention of streptococcal infection is an important part of reducing the incidence of autoimmune rheumatic diseases, patients often show symptoms of respiratory infections such as sore throat, cough, etc., can be treated with appropriate antibiotics, should cure infections, such as chronic tonsillitis , sinusitis, chronic otitis media, dental caries and so on.
6 Avoiding drug abuse: At present, the number of iatrogenic diseases has increased, which has caused widespread concern in the medical community. Since many pharmacological pharmacological effects are not fully understood, drug abuse can easily cause substances with hapten properties to enter the body. Causes immunopathological damage, produces various autoimmune diseases, such as penicillin, penicillamine, chlorpromazine, contraceptives, etc., easily induces SLE, while hydralazine antihypertensive drugs, anticonvulsants such as phenytoin, proca Because of amines, isoniazid, etc., after long-term use of these drugs, symptoms similar to SLE can occur, and autoantibodies can be found in the body, but the symptoms can resolve spontaneously shortly after stopping the drug.
(2) Secondary prevention:
1 early diagnosis: early manifestations of SLE, repeated intermittent fever, joint swelling and pain, fatigue, weakness, serological examination of gamma globulin increased, or detection of autoantibodies, such patients should be alert to autoimmune diseases, further examination is required, also Try to use drugs such as lymphokines that increase cellular immune function, such as transfer factors and interferons, to achieve inhibition, eliminate the role of antigens, and perform diagnostic treatment.
2 early treatment:
(3) Level 3 prevention:
1 patients should be birth control, avoid pregnancy: pregnancy and childbirth can induce systemic lupus erythematosus, is also an important factor to aggravate the condition, and the chance of spontaneous abortion and stillbirth is several times higher than normal.
2 adhere to treatment: especially for the use of hormones and immune modulators should be reviewed regularly.
3 TCM syndrome differentiation: See the Treatment section.
Complication
Systemic lupus erythematosus complications Complications mental retardation mental disorder dementia leukemia lymphoma AIDS systemic lupus erythematosus
Can be combined with hyperthyroidism or hypotension, Sjogren's syndrome and other diseases.
Symptom
Systemic lupus erythematosus symptoms Common symptoms Facial butterfly erythema rash fingertips and fingers (toe)... Pathological alopecia pain fatigue chest pain proteinuria
General symptoms
The ratio of the disease involving men and women is 1:7 to 9, and the age of onset is 20 to 40 years old. The child or the elderly can also develop the disease. Weakness, fever, and weight loss.
1. Skin and mucous membrane
The performance is diverse and can be broadly classified into specific and non-specific. 1 specific lesions have butterfly erythema, subacute cutaneous lupus erythematosus, discoid erythema and neonatal lupus. 2 non-specific skin lesions are photoallergic, hair loss, mouth ulcers, cutaneous vasculitis, Raynaud's phenomenon, urticaria-like rash, rare lupus panniculitis or deep lupus and bullous lupus erythematosus.
3. Skeletal muscles
Table shows joint pain, arthritis, joint deformity (10% X-ray damage) and myalgia, muscle weakness.
4. Heart involvement
There may be pericarditis (4% of patients have signs of pericardial tamponade), myocarditis mainly manifests as congestive heart failure, heart valve disease (Libman-Sacks endocarditis). Coronary arteritis is rare, mainly manifested as chest pain, abnormal ECG and elevated myocardial enzymes.
5. Respiratory system involvement
Pleuritis, pleural effusion (20% to 30%), wrinkling and contracting lung syndrome mainly manifested as hernia and diaphragmatic dysfunction); pulmonary interstitial lesions are seen in 10% to 20% of patients, of which 1% to 4% are Acute lupus pneumonia, pulmonary embolism (5% to 10%, usually anti-cardiolipin antibody positive), pulmonary hemorrhage and pulmonary hypertension (1%) can occur.
6. Kidney
Clinical manifestations of nephritis or nephrotic syndrome. Red blood cells, white blood cells, casts and proteinuria appear in the urine during nephritis. Renal function tests are normal early, gradually progressing, and uremia can occur later. Nephrotic syndrome and laboratory manifestations of systemic edema, with varying degrees of abdominal cavity, chest and pericardial effusion, large amounts of proteinuria, decreased serum albumin, white globulin ratio inversion and hyperlipidemia.
7. Nervous system involvement
May have convulsions, mental disorders, organic brain syndrome including organic amnesia/cognitive dysfunction, dementia and altered consciousness, others may have aseptic meningitis, cerebrovascular accident, transverse myelitis and lupus-like sclerosis , as well as peripheral neuropathy.
8. Blood system
Affected can have anemia, decreased white blood cell count, thrombocytopenia, swollen lymph nodes and splenomegaly.
9. Digestive system
Affected can be anorexia, nausea, vomiting, diarrhea, ascites, liver, abnormal liver function and pancreatitis. Uncommon mesenteric vasculitis, Budd-Chiari syndrome and protein-losing enteropathy.
10. Other
Can be combined with hyperthyroidism or hypotension, Sjogren's syndrome and other diseases.
Examine
Systemic lupus erythematosus examination
1. General inspection
Because SLE patients often have multiple system involvement, such as abnormal blood system and kidney damage, blood tests can have anemia, decreased white blood cell count, and thrombocytopenia. When the kidney is involved, urine analysis can show proteinuria, hematuria, cells and particles. Tube type; erythrocyte sedimentation rate (erythrocyte sedimentation rate) increases during SLE activity, and the remission period can be reduced to normal.
2. Immunological examination
50% of patients have hypoproteinemia, 30% of patients with SLE have hyperproteinemia, especially elevated gamma globulin, and serum IgG levels increase during disease activity. When the disease is active, the level of complement is often reduced because the formation of immune complexes consumes a decrease in the ability of complement and liver to synthesize complement, and the individual complement components C3, C4 and total complement hemolytic activity (CH50) can be reduced during disease activity.
3. Biochemical examination
Liver function tests in patients with SLE were mostly mild to moderate abnormalities, and more often occurred during the course of the disease, accompanied by elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Abnormal serum albumin suggests a decompensation of renal function. Quantitative detection of microalbuminuria in urine function tests helps to determine and monitor the extent and prognosis of kidney damage. In the presence of lupus nephritis, serum urea nitrogen (Bun) and serum creatinine (cr) are helpful in judging clinical stage and observing treatment effects.
SLE patients have a high risk of cardiovascular disease and have gradually attracted great attention in recent years. Some patients with SLE have severe dyslipidemia, elevated inflammatory markers, and high homocysteine (Hcy). Serum lipid levels, hypersensitive C-reactive protein (hs-CRP) and homocysteinemia are considered to be effective predictors of CTD-associated atherosclerotic cardiovascular disease (ASCVD), which can be reduced by periodic testing. The risk of cardiovascular events.
4. Autoantibody detection
Currently, clinical trials of SLE-related autoantibodies are mainly anti-nuclear antibodies (ANA), anti-dsDNA antibodies, anti-ENA antibodies (including anti-Sm, anti-U1RNP, anti-SSA/Ro, anti-SSB/La, anti-rRNP, anti-Scl -70 and anti-Jo-1, etc.), anti-nucleosome antibodies and anti-phospholipid antibodies. For patients with clinically suspected SLE, immunological autoantibody testing should be performed. Among the ACR revised SLE classification criteria, immunological abnormalities and autoantibody positives include: anti-Sm antibodies, anti-dsDNA antibodies, antiphospholipid antibodies, and ANA positive.
5. Histopathological examination
Skin biopsy and renal biopsy are also very helpful in diagnosing SLE. The glomerular performance of the skin lupus test positive and "full hall" is highly specific.
Diagnosis
Diagnosis and differentiation of systemic lupus erythematosus
The diagnosis of SLE relies mainly on clinical manifestations, laboratory tests, histopathology and imaging studies. In the SLE classification standard revised by the American College of Rheumatology (ACR) in 1997, laboratory tests such as hematologic abnormalities, immunological abnormalities, and autoantibody positives were explicitly included in the diagnostic criteria. SLE laboratory examinations are important for the diagnosis, differential diagnosis and judgment of activity and recurrence of SLE.
