The Clinical Observation Of Correlation Between Myocardial Damage And Immune Status In Systemic Lupus Erythematosus

Objective: To explore the relationship between systemic lupus erythematosus(SLE)complicated with heart damage and related immune indexes,so as to provide basis for the condition assessment and treatment of SLE complicated with heart damage.Method: Retrospective analysis on January 1,2017-December 31,2018 in the first affiliated hospital of guangxi medical university were analyzed during the period of 223 cases of patients with systemic lupus erythematosus(SLE),according to the exclusion criteria,88 cases,the remaining 135 cases as as the research object,including SLE combination of 76 patients with cardiac damage as observation group,59 patients with SLE unincorporated heart damage as control group.1.Baseline data and general laboratory tests were analyzed,including age,sex,systolic blood pressure(SBP),diastolic blood pressure(DBP),platelet count(Plt),hemoglobin content(Hb),high-density lipoprotein(HDL),white blood cell count(WBC),and erythrocyte sedimentation rate(ESR).(1)Humoral immune indicators: immunoglobulin G(IgG),immunoglobulin M(IgM),immunoglobulin A(IgA),complement C3,complement C4;(2)CD4+T lymphocyte count,CD8+T lymphocyte count.(3)Anti-nuclear antibody spectrum: ANA,anti-DSDNA quantification,DS-DNA characterization;(4)Anti-phospholipid antibody spectrum(APL): anti-cardiolipin antibody(ACL),anti-neutrophil cytoplasmic antibody(ANCA);(5)Extractable nuclear antigen antibody spectrum(anti-ENA antibody spectrum): anti-SM antibody,anti-SSA,anti-SSB;3.Indicators of heart damage,including creatine kinase isoenzyme(CK-MB)and N-terminal B-type natriuretic peptidogen(NT-Pro BNP);Echocardiographic indicators: left ventricular ejection fraction(LVEF),pulmonary arterial systolic pressure(PAH),pericardial effusion,cardiac valvular disease,ectopic rhythm or conduction block.For patients in the observation group,the increased serum CK-MB,NT-Pro-BNP and PAH of heart damage indicators were used as dependent variables,and the immune indicators were used as independent variables.The bivariate linear correlation was performed,and the correlation was preliminarily analyzed.Then,a Logistic regression analysis model was established with the occurrence of heart damage as the dependent variable and the immune index as the independent variable to screen the immune indexes closely related to heart damage in sle patients.Results: 1.There were no significant differences in age,sex,SBP,DBP,Plt,WBC,ESR,Hb or HDL in SLE with heart damage group(P>0.05).2.The CD8+T lymphocyte count in SLE combined with heart damage group was lower than that in the control group(P<0.05).There were no statistically significant differences in CD4+T lymphocyte count,IgG,IgA,IgM,complement C3,complement C4 and anti-dsdna quantification compared with the control group(P>0.05).There were no statistically significant differences in the positive rates of ANA,anti-double-stranded DNA antibody,anti-sm antibody,anti-ssa antibody,anti-ssb antibody,ACL and ANCA between the two groups(P>0.05).3.Data of CK-MB were collected from 76 patients in SLE with heart damage group,including 14 patients with concentration over 25U/L;The detection data of NT-Pro BNP were 51 cases,including 49 cases with concentration over125fmol/ml.There were 50 patients with LVEF data,and 4 patients with LVEF data reduced to less than 50%.There were 38 PATIENTS with PAH,higher than that of 23 patients with 50 mm Hg.Pericardial ultrasonography in 54 patients and pericardial effusion in 36.There were 57 cases of cardiac valve data and 43 cases of cardiac valve disease.Bundle branch block was found in 2 cases.4.There was no linear correlation between heart damage dominated by ck-mb increase,nt-pro-bnp increase and pulmonary hypertension and IgG,IgA,IgM,complement C3,complement C4,CD4+T lymphocyte count and CD8+T lymphocyte count(all P values were>0.05).5.Considering the dependent variable of heart damage(with or without),the immune index was incorporated as independent variable into the Logistic regression analysis model of bivariate variables for analysis,and it was found that increased CD8+T lymphocyte count and increased IgG were important risk factors for heart damage in patients with systemic lupus erythematosus(P<0.05).However,CD4+T lymphocyte count,IgM,IgA,anti-dsdna quantification,ANA,anti-double-stranded DNA antibody,anti-sm antibody,anti-ssa antibody,anti-ssb antibody,ACL,ANCA and sle complicated with heart damage had no significant influence(all P >0.05).Conclusion: Heart damage in patients with systemic lupus erythematosus was positively correlated with CD8+T lymphocyte count and IgG levels.