Journal of Peking University(Health Sciences) ›› 2018, Vol. 50 ›› Issue (6): 1004-1008. doi: 10.19723/j.issn.1671-167X.2018.06.011

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Clinical and immunological characteristics of patients with systemic lupus erythematosus in Tibet plateau, China

Jiao YANG1,Hai-hong YAO2,Xiao-dong MO3,Zeng LUO1,yang-jin Bai-ma1,()   

  1. 1. Department of Rheumatology and Immunology, Tibet Autonomous Region People’s Hospital, Lhasa 850000, China
    2. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China
    3. Department of Hemotology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2018-03-29 Online:2018-12-18 Published:2018-12-18
  • Contact: yang-jin Bai-ma E-mail:19960004@tarph.com

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Abstract:

Objective: To describe the clinical, immunological characteristics and organ involvement of patients with systemic lupus erythematosus (SLE) in Tibet plateau, China.Methods:We retrospectively investigated 70 patients admitted in the Tibet Autonomous Region People’s Hospital between May 2014 and April 2016. In the study, 120 hospitalized patients with SLE from the Department of Rheumatology and Immunology of the Peking University People’s Hospital were randomly selected as the control (plain) group. The major organ involvement, clinical and immunological characteristics were compared between the two groups.Results:The female to male ratio of Tibet plateau group was 10.7, while the correspon-ding ratio of plain group was 11.0. The mean age at disease diagnosis was (32.21±11.40) and (35.38±13.25) years, respectively. the most common initial manifestations of SLE were arthritis (78.6%), alopecia (55.7%) and malar rash (48.6%) in Tibet plateau group, the prevalence of arthritis and alopecia was significantly higher than in plain group (P<0.05). The incidence of neuropsychiatric and kidney involvement was significantly lower in Tibet plateau group compared with plain group (P<0.05). As for the serological manifestations, the positivity of anti-double-stranded DNA (dsDNA) (57.1%), anti-Smith (Sm) antibody (55.7%), anti-Sj?gren syndrome A (SSA) antibody (72.3%), anti-Sj?gren syndrome B (SSB) antibody (41.4%) and anti-u1-ribosenuclear protein (u1RNP) antibody (45.7%) was significantly higher in Tibet plateau group (P<0.05). While the incidence of low serum complement C3 (61.4%), C4 (38.6%) less frequent in Tibet plateau group. Mean SLE disease activity index (SLEDAI) score was similar in the Tibet plateau group (12.18±5.58) and plain group (12.69±7.28). Moreover, there were 13 (18.6%) SLE patients suffering from tuberculosis and 7 (10%) SLE patients infected with hepatitis B virus in Tibet plateau group. The number of recent-onset SLE patients with lower 25-dihydroxy-vitamin D3 (25-OH-VD3) in Tibet plateau group was fewer than that in the plain group (76.7% vs. 90.0%, P=0.046). Serum 25-OH-VD3 levels in Tibet plateau plateau group were (31.14±18.74) nmol/L, those in plain group were (26.91±14.27) nmol/L, and the difference was not significant.Conclusion:The age, gender and SLEDAI scores in Tibet plateau group was similar to those in plain group. But there are significant differences in clinical manifestations, distributions of antibodies and immunological changes between Tibet plateau group and plain group. The patients with lower serum 25-OH-VD3 levels were more in plain group than in Tibet plateau group, while there was no signi-ficant difference in the 25-OH-VD3 level between the two groups.

Key words: Lupus erythematosus, systemic, Tibet, Biological markers, Symptoms and signs

CLC Number: 

  • R593.241

Table 1

Comparison of general situation in SLE patients between the Tibet plateau group and the plain group"

General situation Tibet plateau
group (n=70)
Plain group
(n=120)
P
Female, n(%) 64 (91.4) 110 (91.7) 0.955
Onset age/years, x-±s 33.21±11.40 35.38±13.25 0.213
SLEDAI score, x-±s 12.19±5.58 12.69±7.28 0.596

Table 2

Comparison of common clinical features in SLE patients between Tibet plateau group and plain group n(%)"

Clinical features Tibet plateau
group (n=70)
Plain group
(n=120)
P
Malar rash 34 (48.6) 65 (54.2) 0.456
Arthritis 55 (78.6) 45 (37.5) <0.001
Hair loss 39 (55.7) 38 (31.7) 0.001
Fever 17 (27.3) 36 (30.0) 0.397
Oral ulcers 17 (27.3) 19 (15.8) 0.152
Raynaud phenomenon 4 (5.7) 15 (12.5) 0.133

Table 3

Comparison of involved organs in SLE patients between the Tibet plateau group and the plain group"

Items Tibet plateau
group (n=70)
Plain group
(n=120)
P
Blood system 49 (70.0) 76 (63.3) 0.350
Urinary system
Lupus nephritis 27 (38.6) 68 (56.7) 0.016
Cystitis 0 1 (0.8) >0.990
Retinal vasculitis 2 (4.3) 4 (3.3) >0.990
Neuropsychiatric lupus 2 (2.9) 21 (17.5) 0.003
Respiratory system
Interstitial lung disease/
Pulmonary fibrosis
6 (8.6) 16 (13.3) 0.322
Valvular hemorrhage 3 (4.3) 4 (3.3) 0.709
Cardiovascular system
Valvular heart disease 0 2 (1.7) >0.992
Pulmonary hypertension 6 (8.6) 15 (12.5) 0.405
Digestive system
Autoimmune pancreatitis 2 (2.9) 2 (1.7) 0.623
Mesenteric vasculitis 2 (2.9) 4 (3.3) >0.989
Liver injury 3 (4.3) 12 (10.0) 0.163
Myositis 2 (2.9) 10 (8.3) 0.131

Table 4

Serological comparison of SLE patients in the Tibet plateau group and the plain groupn(%)"

Items Tibet plateau
group (n=70)
Plain group
(n=120)
P
ANA+ 66(94.3) 112(93.3) 0.795
Anti-dsDNA+ 40(57.1) 48(40.0) 0.022
Anti-Sm+ 39(55.7) 10(8.3) <0.001
Anti-SSA+ 52(74.3) 40(33.3) <0.001
Anti-SSB+ 29(41.4) 7(5.8) <0.001
Anti-u1RNP+ 32(45.7) 24(20.0) <0.001
ACL+ 16(22.9) 33(27.5) 0.480
C3↓ 43(61.4) 105(87.5) <0.001
C4↓ 27(38.6) 92(76.7) <0.001

Figure 1

SLE patients with 25-OH-VD3 reducedA, comparison of systemic lupus erythematosus (SLE) patients 25-dihydroxy-vitamin D3 (25-OH-VD3) reduced between the Tibet plateau group and plain group; B, comparison of the SLE disease activity index (SLEDAI) scores between 25-OH-VD3 reduced group and normal group in SLE patients of Tibet plateau group; C, analysis of 25-OH-VD3 level and anti-double-stranded DNA (dsDNA) in Tibet plateau group (P=0.57); D, analysis of 25-OH-VD3 level and lupus nephritis (LN) in Tibet plateau group (P=0.84)."

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