Clinical Analysis Of Systemic Lupus Erythematosus Complicated With Interstitial Pneumonia

Background:Systemic lupus erythematosus(systemic lupus erythematosus,SLE)is an autoimmune disease characterized by multiple organ involvement and multiple autoantibodies.Interstitial pneumonia(IP)is one of the common manifestations of lung involvement in SLE,which seriously affects patients’ quality of life and prognosis.However,the onset of interstitial pneumonia is concealed and lacks specific serum markers,so it is not easy to diagnose early,and often patients have irreversible fibrotic lesions at the time of diagnosis.Objectives:The aim of this study was to analyze the high-resolution CT findings of patients with systemic lupus erythematosus complicated by interstitial pneumonia(SLE-IP)and to analyze the distribution of interstitial lesions to improve the understanding of SLEIP imaging characteristics.At the same time,to explore the clinical features,early predictive indicators and new therapeutic targets of SLE-IP patients,we analyzed the general clinical data of SLE-IP patients and the characteristics of laboratory tests,especially the characteristics of peripheral blood lymphocyte。 Methods:The study included 30 SLE-IP patients.The distribution of lung high-resolution computed tomography(HRCT)and interstitial lesions in SLE-IP patients were statistically analyzed.At the same time,30 patients without IP SLE were selected as the control group(SLE-NIP).Compare and analyze gender,age,duration of disease,smoking history,BMI,initial symptoms,accompanying symptoms and disease activity scores(SLEDAI).The following laboratory indicators were collected and compared for differences between the two groups: ? Routine blood tests: WBC,RBC,Hb,PLT,LYM.?inflammation and immunological indicators: ESR,CRP,IgA,IgG,IgM,C3,C4,PALB,ALB.?Peripheral blood lymphocyte subsets(CD3+ lymphocytes,CD3+CD8+ lymphocytes,CD3-CD19+ lymphocytes,CD3+CD4+ lymphocytes,CD3-CD16+CD56+ cell expression percentage,CD3+CD4+/CD3+ CD8+ cell ratio).?Autoantibodies: ANA,anti-Sm antibody,anti-U1-RNP antibody,anti-dsDNA antibody,anti-SSA antibody,anti-RO-52 antibody,anti-SSB antibody,anti-Scl-70 antibody,anti-Pm-Scl antibody,anti-Jo-1 Antibody,anti-CENP B antibody,antiPCNA antibody,anti-neutrophil cytoplasmic antibody(ANCA),anticardiolipin antibody(APL).?Myocardial zymogram: AST,LDH,CK,CK-MB,HBDH,HCY.? The renal function and urine routine indicators(without lupus nephritis in the two groups.)included: CREA,RBP,CysC,UREA,URIC,blood α1-MG,urine α1-MG,urine MA,UTFR,NAG.Results:Compared with patients in the SLE-NIP group,patients in the SLE-IP group had a longer duration of disease(P=0.049)and higher SLEDAI scores(P=0.005).There was no significant difference in gender,smoking history,age,and BMI between the two groups.(P>0.05).?Numbers of patients SLE-NIP group as the first symptom in hair loss was significantly higher than the patients with SLE-IP group(P= 0.044).The proportion of patients in SLE-IP group with dry mouth,dry eyes,chest tightness/air shortness was significantly higher than that of SLE-NIP group(P <0.05).?Highresolution computed tomography of the chest most disclosed ground-glass shadow,with a 50% involvement rate,followed by nodular shadow,with the least proportion of honeycombs and grids.From the overall distribution,the interstitial lesions are mainly distributed in the lower and peripheral parts.?The RBC values of patients in the SLEIP group were significantly lower than those in the SLE-NIP group(P =0.002).Hb levels were lower in the SLE-IP group than in the SLE-NIP group(P =0.029).?The levels of ESR,IgG and IgA in SLE-IP group were significantly higher than those in SLE-NIP group(P<0.01).The levels of PALB and ALB in SLE-IP group were significantly lower than those in SLE-NIP group(P<0.01).?Peripheral blood lymphocyte subsets were compared between the two groups: the percentage of CD3+ lymphocytes in the SLE-IP group was significantly lower than that in the SLE-NIP group(P =0.008),and the percentage of CD3+CD8+ lymphocytes was significantly lower than that in the SLE-NIP group(P =0.006),the percentage of CD3-CD19+ lymphocyte expression was significantly higher than that of the SLE-NIP group(P =0.032).There was no statistically significant difference between the two groups in the percentage of CD3+CD4+ lymphocytes,CD3-CD16+CD56+ cells and the ratio of CD3+CD4+/CD3+CD8+(P >0.05).?There was no statistically significant difference between the two groups in autoantibodies positive rate.(P>0.05).?The levels of AST,LDH,CK and HBDH in the SLE-IP group were significantly higher than those in the SLE-NIP group(P<0.01).?The levels of CREA,CysC,UREA,and urinary α1-MG in the SLE-IP group without lupus nephritis(LN)were significantly higher than those in the SLE-NIP group without LN(n=22)(P <0.05).Conclusion:Understanding the imaging manifestations and clinical symptoms of SLE-IP patients is conducive to the early diagnosis,treatment and prognosis improvement.SLE-IP patients are often complicated with hematological,renal,and cardiac involvement.SLE-IP patients have the characteristics of long course and high disease activity.For SLE patients with significant increase in ESR,IgG and IgA,and significant decrease in PALB and ALB,persistent activation of B-cell function,HRCT examination should be improved as early as possible and need to be alert to the occurrence of interstitial pneumonia。Drugs targeting B cells may become effective treatments for SLE-IP.