系统性红斑狼疮合并肺动脉高压患者外周血
T淋巴细胞亚群水平变化及临床意义

doi:10.3877/cma.j.issn.2095-655X.2024.01.006

摘要
图/表
参考文献
相关文章 (2)

全文: PDF (690 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨系统性红斑狼疮（SLE）合并肺动脉高压(PH)患者外周血T淋巴细胞亚群水平变化及临床意义。方法收集2020年1月至2023年1月在济宁医学院附属医院风湿免疫科住院治疗的121例活动期SLE患者，根据有无肺动脉高压分为PH组(n=57)与无PH组(n=64)，检测并比较两组的一般资料、T淋巴细胞亚群（CD3+、CD4+、CD8+、CD4+/CD8+）。采用Spearman相关性分析T淋巴细胞亚群与SLE患者肺动脉收缩压的相关性，采用二元Logistic回归分析SLE发生PH的影响因素，采用受试者工作特征(ROC)曲线评估相关指标对SLE患者PH的预测价值。结果PH组与无PH组在年龄、性别、病程、体重指数、SLE疾病活动指数（SLEDAI）评分比较，均差异无统计学意义（均P＞0.05）。PH组CD3+T淋巴细胞水平［79.88（71.31，86.60）%］、CD8+T淋巴细胞水平［44.61（32.02，59.61）%］高于无PH组CD3+T淋巴细胞水平［75.24（66.19，81.60）%］、CD8+T淋巴细胞水平［33.17（26.57，40.42）%］，PH组CD4+T淋巴细胞水平［31.33（21.25，41.50）%］、CD4+/CD8+［0.67（0.45，1.17）］低于无PH组CD4+T淋巴细胞水平［40.03（29.95，51.26）%］、CD4+/CD8+比值［1.25（0.84，1.67）］，均差异有统计学意义（Z=1.99,3.73,3.15,4.03；均P＜0.05）。Spearman相关性分析结果显示，SLE患者肺动脉收缩压与CD4+T淋巴细胞水平（r=-0.297）、CD4+/CD8+（r=-0.357）呈负相关（均P＜0.05），与CD8+T淋巴细胞水平（r=0.316）呈正相关（P＜0.01）。二元Logistic回归分析结果显示，CD8+T淋巴细胞水平升高（OR=1.108，P＜0.01）是发生PH的危险因素，CD4+T淋巴细胞水平升高（OR=0.092，P＜0.01）是发生PH的保护因素。ROC曲线结果显示，CD3+、CD4+、CD8+T淋巴细胞水平和CD4+/CD8+以及联合检测预测SLE合并PH的AUC分别为0.605、0.666、0.697、0.713、0.794，均有良好的预测效能（均P＜0.05），其中联合预测效能高于单项。结论外周血T淋巴细胞亚群异常与SLE合并PH相关，其对于病情的评估具有较高的价值，可作为一项重要的参考指标，对临床诊治和疾病预后预测有一定的指导意义。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ：系统性红斑狼疮, 肺动脉高压, T淋巴细胞亚群, 疾病相关性, 预测价值

Abstract：ObjectiveTo investigate the changes and clinical significance between the peripheral blood T lymphocyte subsets in systemic lupus erythematosus(SLE) patients with pulmonary hypertension(PH). MethodsA total of 121 active SLE patients diagnosed in Affiliated Hospital of Jining Medical University from January 2020 to January 2023 were selected as the research objects into PH group (n=57) and non-PH group (n=64). The general data and T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) in the 2 groups were detected and compared. The correlation between T lymphocyte subsets and pulmonary artery systolic pressure in SLE patients were analyzed by Spearman′s correlation coefficient, and binary Logistic regression was used to analyse the factors influencing SLE-PH. Receiver operating characteristic（ROC） curve analysis was performed to analyze the predictive value of relevant indicators in these patients. ResultsThe general data of PH and non-PH group, such as age, sex, course of disease, BMI and SLEDAI score had no statistically significant difference (all P＞0.05). CD3+ T lymphocyte level［79.88（71.31，86.60）%, 75.24（66.19，81.60）%］ and CD8+ T lymphocyte level［44.61（32.02，59.61）%, 33.17（26.57，40.42）%］ were higher in the PH group than those in the non-PH group. CD4+ T lymphocyte level［31.33（21.25，41.50）%, 40.03（29.95，51.26）%］, CD4+/CD8+［0.67（0.45，1.17）, 1.25（0.84，1.67）］ in the PH group were lower than those in the non-PH group, and the differences were statistically significant (Z=1.99, 3.73, 3.15, 4.03, all P＜0.05). Spearman correlation analysis showed that the pulmonary artery systolic pressure in SLE patients was negatively correlated with CD4+ T lymphocyte level （r=-0.297, P＜0.01） and CD4+/CD8+ level（r=-0.357, P＜0.05）, and positively correlated with CD8+ T lymphocyte level （r=0.316, P＜0.01）. Binary Logistic regression analysis showed that high CD8+ T lymphocyte level (OR=1.108, P＜0.01］ was the risk factor for developing PH, and high CD4+ T lymphocyte level (OR=0.092， P＜0.01) was the protective factor for developing PH. The ROC curve results showed that the AUCs for CD3+, CD4+, CD8+ T lymphocyte level, CD4+/CD8+ and the combined test predicted SLE combined with PH were 0.605, 0.666, 0.697, 0.713 and 0.794, respectively, all had good predictive efficacy (all P＜0.05), and the combined prediction efficiency was higher than that of single detection. ConclusionsAbnormal levels of peripheral blood T lymphocyte subsets are associated with SLE combined with PH, which hold significant value for the evaluation of the disease. It can serve as an important reference index, and offer substantial guidance for clinical diagnosis and treatment and disease prognosis prediction.

Key words： Systemic lupus erythematosus Pulmonary arterial hypertension T lymphocyte subsets Disease correlation Predictive value

收稿日期: 2023-09-02

基金资助:济宁市重点研发计划（2021YXNS039）

通讯作者: 宋芹， Email:songqin1230@163.com

引用本文:

孟丽君宋芹邵莉李健. 系统性红斑狼疮合并肺动脉高压患者外周血 T淋巴细胞亚群水平变化及临床意义[J]. 中华诊断学电子杂志, 2024, 12(1): 38-43.
Meng Lijun, Song Qin, Shao Li, Li Jian. Changes and clinical significance of peripheral blood T lymphocyte subsets in systemic lupus erythematosus patients complicated with pulmonary hypertension. zhzdx, 2024, 12(1): 38-43.

链接本文:

http://www.zhzdxzz.com/CN/10.3877/cma.j.issn.2095-655X.2024.01.006 或 http://www.zhzdxzz.com/CN/Y2024/V12/I1/38

［1］Zen M，Salmaso L，Barbiellini Amidei C，et al.Mortality and causes of death in systemic lupus erythematosus over the last decade：Data from a large population-based study［J］.Eur J Intern Med，2023（112）:45-51.DOI：10.1016/j.ejim.2023.02.004. ［2］Humbert M，Montani D，Evgenov OV，et al.Definition and classification of pulmonary hypertension［J］.Handb Exp Pharmacol，2013（218）:3-29.DOI：10.1007/978-3-642-38664-0_1. ［3］Huertas A，Tu L，Humbert M，et al.Chronic inflammation within the vascular wall in pulmonary arterial hypertension：more than a spectator［J］.Cardiovasc Res，2020，116(5):885-893.DOI：10.1093/cvr/cvz308. ［4］于晓东,贺宝军,刘羽璇霖，等.T淋巴细胞亚群相关细胞因子与系统性红斑狼疮疾病的相关性及机制研究［J］.中国免疫学杂志,2022,38(23):2906-2912.DOI：10.3969/j.issn.1000-484X.2022.23.017. ［5］刘怡,谭静雅,卿红梅，等.系统性红斑狼疮患者外周血T淋巴细胞亚群和亲环素A的表达及临床意义［J］.分子诊断与治疗杂志,2021,13(6):885-888，892.DOI:10.19930/j.cnki.jmdt.2021.06.010. ［6］Aringer M，Costenbader K，Daikh D，et al.2019 European league against rheumatism/American college of rheumatology classification criteria for systemic lupus erythematosus［J］.Ann Rheum Dis，2019，78(9):1151-1159.DOI：10.1136/annrheumdis-2018-214819. ［7］中华医学会心血管病学分会肺血管病学组,中华心血管病杂志编辑委员会.中国肺高血压诊断和治疗指南2018［J］.中华心血管病杂志,2018,46(12)：933-964.DOI:10.3760/cma.j.issn.0253-3758.2018.12.00. ［8］Humbert M，Kovacs G，Hoeper MM，et al.2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension［J］.Eur Heart J，2022，43(38):3618-3731.DOI：10.1093/eurheartj/ehac237. ［9］张晓，赵久良，丁峰，等.结缔组织病相关肺动脉高压诊疗规范［J］.中华内科杂志，2022，61(11):1206-1216.DOI：10.3760/cma.j.cn112138-20220309-00164. ［10］Poch D，Mandel J.Pulmonary hypertension［J］.Ann Intern Med，2021，174(4):ITC49-ITC64.DOI：10.7326/AITC202104200. ［11］Li M，Zhang W，Leng X，et al.Chinese SLE treatment and research group (CSTAR) registry：I.Major clinical characteristics of Chinese patients with systemic lupus erythematosus［J］.Lupus，2013，22(11):1192-1199.DOI:10.117710961203313499086. ［12］Paredes JL， Fernandez-Ruiz R， Niewold TB. T cells in systemic lupus erythematosus［J］.Rheum Dis Clin North Am，2021，47(3):379-393.DOI：10.1016/j.rdc.2021.04.005. ［13］Saadh MJ，Kazemi K，Khorramdelazad H，et al.Role of T cells in the pathogenesis of systemic lupus erythematous： focus on immunometabolism dysfunctions［J］.Int Immunopharmacol，2023(119):110246.DOI：10.1016/j.intimp.2023.110246. ［14］Lu Z，Li W，Tang Y，et al.Lymphocyte subset clustering analysis in treatment-naive patients with systemic lupus erythematosus［J］.Clin Rheumatol，2021，40(5):1835-1842.DOI：10.1007/s10067-020-05480-y. ［15］Yuan S， Zeng Y， Li J， et al. Phenotypical changes and clinical significance of CD4(+)/CD8(+) T cells in SLE［J］.Lupus Sci Med，2022，9(1):e000660.DOI：10.1136/lupus-2022-000660. ［16］张钟元,刘姗姗,王凯，等.系统性红斑狼疮患者血清TNF-α表达与T淋巴细胞亚群的关系［J］.分子诊断与治疗杂志,2022,14(11):1883-1886.DOI：10.19930/j.cnki.jmdt.2022.11.041. ［17］史阳阳，徐杰，史薪炜，等.系统性红斑狼疮相关肺动脉高压发病机制研究进展［J］.医学综述，2022，28(8):1480-1484.DOI：10.3969/j.issn.1006-2084.2022.08.005. ［18］Parperis K，Velidakis N，Khattab E，et al.Systemic lupus erythematosus and pulmonary hypertension［J］.Int J Mol Sci，2023，24(6):5085.DOI：10.3390/ijms24065085. ［19］Qian J，Chen Y，Yang XZ，et al.Association study identified HLA-DQA1 as a novel genetic risk of systemic lupus erythematosus-associated pulmonary arterial hypertension.Arthritis Rheumatol［J］.Arthritis Rheumatol，2023,75(12):2207-2215.DOI：10.1002/art.42641. ［20］辛晓红，茹美华，张升校，等.结缔组织病相关肺动脉高压患者肠道菌群分布变化与外周血T淋巴细胞亚群和细胞因子的相关性分析［J］.中国分子心脏病学杂志，2021，21(3):4010-4016.DOI：10.16563/j.cnki.1671-6272.2021.06.021. ［21］张桥，刘温娟，王婵娟，等.BNP、CRP水平和T淋巴细胞亚群百分比变化在慢性阻塞性肺疾病合并肺动脉高压中的意义［J］.检验医学与临床，2022，19(20):2791-2794,2798.DOI：10.3969/j.issn.1672-9455.2022.20.013. ［22］童艳，张泉，邵亚，等.外周血T细胞亚群在慢性肾脏病透析患者中的表达与出现肺动脉高压的相关性［J］.临床和实验医学杂志，2020，19(21):2306-2309.DOI：10.3969/j.issn.1671-4695.2020.21.019. ［23］陈晶，张晓刚，李玮，等.外周血T淋巴细胞在系统性红斑狼疮合并肺动脉高压患者中的表达及临床意义［J］.标记免疫分析与临床，2022，29(11):1906-1911.DOI：10.11748/bjmy.issn.1006-1703.2022.11.022.