Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (2): 266-272. doi: 10.19723/j.issn.1671-167X.2021.02.006

Previous Articles     Next Articles

Clinical characteristics and related factors of systemic lupus erythematosus with interstitial pneumonia

XIA Fang-fang1,LU Fu-ai1,LV Hui-min1,YANG Guo-an2,Δ(),LIU Yuan3,Δ()   

  1. 1. Department of Rheumatology, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia, China
    2. Central Laboratory, First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou 014010, Inner Mongolia, China
    3. Department of Rheumatology, Taizhou First People’s Hospital, Taizhou 318000, Zhejiang, China
  • Received:2019-03-24 Online:2021-04-18 Published:2021-04-21
  • Contact: Guo-an YANG,Yuan LIU E-mail:0331004@163.com;liuyuanem@163.com
  • Supported by:
    Natural Science Foundation of Inner Mongolia(2017MS(LH)0812);Research Funds of Baotou Medical College(BYJJ-YF 2016100)

RICH HTML

   

PDF (PC)

Abstract:

Objective: To investigate the clinical features, radiologic scores and clinically relevant risk factors prognosis of secondary interstitial lung disease (ILD) in patients with systemic lupus erythematosus (SLE). Methods: In this study, 60 SLE patients in Department of Rheumatology of the First Affiliated Hospital of Baotou Medical College and Taizhou First People’s Hospital from January 2015 to March 2019 were retrospectively analyzed. All of those 60 patients with SLE underwent lung high resolution computed tomography (HRCT) examination. We used a 1 ∶1 case-control study. There was a matching of age and gender between the two groups. Thirty patients with SLE related ILD (SLE-ILD) were in the case group, and 30 patients with SLE without ILE (SLE non-ILD) were in the control group. The clinical features, pulmonary function test, radiologic characteristic of SLE patients were collected and were used to analyze SLE-ILD. Results: In this study, we reached the following conclusions: First, there were statistically significant differences in chest tightness/shortness of breath, Raynaud’s phenomenon, and Velcro rale between SLE-ILD and SLE non-ILD patients (both P<0.05); Second, hemoglobin (Hb) and albumin (ALB) in the patients of SLE-ILD had a significant decrease compared with the patients of SLE non-ILD. Blood urea nitrogen (BUN), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) increased in SLE-ILD patients compared with SLE non-ILD patients, the difference had statistical significance (P<0.05); Third, for SLE-ILD patients, the most common type was non-specific interstitial pneumonia (NSIP), followed by usual interstitial pneumonia and lymphocytic interstitial pneumonia; Fourth, there was no significant difference in clinical-radiology-physiology scores between the different ILD types (P>0.05), similarly, the lung HRCT score and lung function between different ILD types had no significant difference (P>0.05); Fifth, multivariate Logistic regression analysis showed that decreased albumin and chest tightness/shortness of breath might be the risk factor for SLE-ILD. Conclusion: There are statistically significant differences between the SLE-ILD group and SLE non-ILD group in terms of chest tightness/shortness of breath, Velcro rale and Raynaud’s phenomenon. Decreased albumin and chest tightness/shortness of breath in SLE patients should be alerted to the occurrence of ILD. NSIP is the most common manifestation of SLE-ILD.

Key words: Systemic lupus erythematosus, Interstitial lung diseases, Clinical features, Risk factors

CLC Number: 

  • R593.24

Table 1

Clinical manifestations of SLE-ILD and SLE non-ILD patients"

Clinical
manifestation		 Fever, n (%) Dry cough, n (%) Chest tightness,
n (%)		 Chest pain, n (%) Velcro, n (%) Clubbing, n (%)
Yes No Yes No Yes No Yes No Yes No Yes No
SLE-ILD 16 (53) 14 (47) 9 (30) 21 (70) 22 (73) 8 (27) 2 (6) 28 (94) 18 (60) 12 (40) 3 (10) 27 (90)
SLE non-ILD 14 (47) 16 (53) 9 (30) 21 (70) 12 (40) 18 (60) 3 (10) 27 (90) 10 (33) 20 (67) 1 (3) 29 (97)
χ2 0.267 0.000 6.787 0.000 4.286 0.268
P 0.606 1.000 0.009# >0.999 0.038* 0.605
Clinical
manifestation		 Rash, n (%) Arthritis, n (%) Oral ulcer,
n (%)		 Raynaud’s
phenomenon,
n (%)		 Light allergy,
n (%)		 Myalgia/muscle
weakness, n (%)		 Hair loss,
n (%)
Yes No Yes No Yes No Yes No Yes No Yes No Yes No
SLE-ILD 15 (50) 15 (50) 17 (56) 13 (44) 10 (33) 20 (67) 17 (56) 13 (44) 1 (3) 29 (97) 16 (53) 14 (47) 10 (33) 20 (67)
SLE non-ILD 16 (53) 14 (47) 19 (63) 11 (37) 9 (30) 21 (70) 8 (26) 22 (74) 6 (20) 24 (80) 15 (50) 15 (50) 5 (16) 25 (84)
χ2 0.067 0.278 0.077 5.554 2.588 0.067 2.222
P 0.796 0.598 0.781 0.018* 0.108 0.796 0.136

Table 2

Laboratory test indexes of SLE-ILD and SLE non-ILD patients ($\bar{x} \pm s$)"

Items SLE-ILD (n=30) SLE non-ILD (n=30) F P
WBC/(×109 cells/L) 6.04±2.04 5.75±1.99 0.305 0.583
Hb/(g/L) 121.73±24.27 135.03±14.25 6.700 0.012*
PLT/(×109 cells/L) 178.23±84.84 194.80±75.36 0.639 0.427
ALT/(U/L) 24.76±20.23 25.06±12.67 0.005 0.944
ALB/(g/L) 38.02±9.83 42.27±4.24 4.726 0.034*
BUN/(mmol/L) 9.90±8.94 6.34±2.91 4.303 0.042*
Scr/(μmol/L) 96.84±58.40 69.70±21.07 5.722 0.020*
C3/(g/L) 0.85±0.28 0.93±0.24 1.301 0.259
C4/(g/L) 0.20±0.09 0.18±0.08 1.674 0.201
IgA/(g/L) 3.03±1.12 3.10±1.23 0.054 0.817
IgM/(g/L) 0.64±0.34 0.75±0.47 1.133 0.292
IgG/(g/L) 14.02±5.24 11.76±2.97 4.219 0.044*

Table 3

Laboratory test indexes of SLE-ILD and SLE non-ILD patients [M (P25, P75)]"

Items SLE-ILD SLE non-ILD Statistics P
UTP 0.30 (0.00, 0.97) 0.00 (0.00, 0.21) -0.673 0.501
ESR 55 (15, 114) 8 (7, 15) -10.822 <0.001
CRP 48.80 (12.20, 57.00) 4.18 (3.13, 8.98) -12.427 <0.001

Table 4

Autoantibodies of patients with SLE-ILD and SLE non-ILD"

Group ANA dsDNA Sm SSA
(Ro-52 kDa)		 SSA
(60 kDa)		 SSB RNP nRNP/Sm
+ - + - + - + - + - + - + - + -
SLE-ILD, n 28 2 16 14 13 17 14 16 15 15 8 22 8 22 15 15
SLE non-ILD, n 26 4 15 15 10 20 9 21 12 18 4 26 13 17 15 15
χ2 0.185 0.067 0.635 0.184 0.436 0.938 1.832 0.000
P 0.667 0.796 0.426 1.763 0.606 0.333 0.176 >0.999

Table 5

Comparison of clinical-radiology-physiology score, HRCT and pulmonary function in patients with different ILD types of SLE-ILD ($\bar{x} \pm s$)"

Items Clinical-radiology-physiology score HRCT score FVC/(%pred) DLCO/(%pred)
UIP 19.29±8.34 2.43±2.15 90.71±25.76 66.71±14.95
NSIP 19.00±12.73 1.00±0.62 69.00±29.70 53.00±39.60
F 0.002 0.748 1.056 0.704
P 0.97 0.42 0.34 0.43

Table 6

Clinical manifestations of SLE-ILD and SLE non-ILD patients"

Group Blood system, n (%) Renal system, n (%) Nervous system, n (%) Cardiovascular system, n (%)
Yes No Yes No Yes No Yes No
SLE-ILD 23 (77) 7 (23) 10 (33) 20 (67) 4 (13) 26 (87) 6 (20) 24 (80)
SLE non-ILD 21 (70) 9 (30) 15 (50) 15 (50) 2 (7) 28 (93) 7 (23) 23 (77)
χ2 0.559 0.190 0.667 0.754
P 0.341 1.714 0.185 0.098

Table 7

Univariate Logistic regression analysis results of risk factors related to SLE-ILD"

Items B SE P
Chest tightness 0.339 0.125 0.009
Raynaud’s phenomenon 0.309 0.127 0.018
Velcro 0.268 0.127 0.039
Hb↓ 0.417 0.155 0.009
ALB↓ 0.501 0.156 0.002
BUN↑ 0.278 0.129 0.035
CRP↑ 0.39 0.162 0.019
ESR↑ 0.144 0.135 0.292
IgG -0.032 0.015 0.044

Table 8

Multivariate Logistic regression analysis results of risk factors related to SLE-ILD"

Items B SE Wald P OR 95%CI
Chest tightness 1.570 0.624 6.323 0.012 4.808 1.414-16.348
Albumin ↓ 2.848 1.137 6.276 0.012 17.255 1.859-160.185
[1] Weinrib L, Sharma OP, Quismorio FP Jr. A long-term study of interstitial lung disease in systemic lupus erythematosus[J]. Semin Arthritis Rheum, 1990,20(1):48-56.
[2] 陈恒屹, 康军, 崔社怀, 等. 特发性肺间质纤维化合并肺气肿的临床特征分析[J]. 中华肺部疾病杂志:电子版, 2014,7(1):7-11.
[3] Wu XY, Yang M, Xie YS, et al. Causes of death in hospitalized patients with systemic lupus erythematosus: a 10-year multicenter nationwide Chinese cohort[J]. Clin Rheumatol, 2019,38(1):107-115.
[4] Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus[J]. Arthritis Rheum, 2012,64(8):2677-2686.
pmid: 22553077
[5] Travis WD, Costabel U, Hansell DM, et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias[J]. Am J Respir Crit Care Med, 2013,188(6):733-748.
pmid: 24032382
[6] Gay SE, Kazerooni EA, Toews GB, et al. Idiopathic pulmonary brosis: predictingresponse to therapy and survival[J]. Am J Respir Crit Care Med, 1998,157(4 Pt 1):1063-1072.
pmid: 9563720
[7] Hamblin MJ, Horton MR. Rheumatoid arthritis-associated interstitial lung disease: diagnostic dilemma[J]. Pulm Med, 2011,87(3):87-92.
[8] Gutsche M, Rosen GD, Swigris JJ. Connective tissue disease-associated interstitial lung disease: a review[J]. Curr Respir Care Rep, 2012,1(4):224-232.
[9] 陈晓芳, 杨敏, 赵进军, 等. 系统性红斑狼疮合并间质性肺炎的临床特征及相关危险因素分析[J]. 重庆医学, 2018,47(11):1460-1464.
[10] Mittoo S, Fell CD. Pulmonary manifestations of systemic lupus erythematosus[J]. Semin Respir Crit Care Med, 2014,35(2):249-254.
[11] Aguilera-Pickens G, Abud-Mendoza C. Pulmonary manifestations in systemic lupus erythematosus: pleural involvement, acute pneumonitis, chronic interstitial lung disease and diffuse alveolar hemorrhage[J]. Reumatol Clin, 2018,14(5):294-300.
pmid: 29773465
[12] Walsh SL, Habsell DM. High-resolution CT of interstitial lung disease: a continuous evolution[J]. Semin Respir Crit Care Med, 2014,35(1):129-144.
pmid: 24481766
[13] Hunninghake GW, Lynch DA, Galvin JR, et al. Radiologic findings are strongly associated with a pathologic diagnosis of usual interstitial pneumonia[J]. Chest, 2003,124(4):1215-1223.
pmid: 14555549
[14] Tansey D, Wells AU, Colby TV, et al. Variations in histological patterns of interstitial pneumonia between connective tissue disorders and their relationship to prognosis[J]. Histopathology, 2004,44(6):585-596.
pmid: 15186274
[15] Palmucci S, Roccasalva F, Puglisi S, et al. Clinical and radiolo-gical features of idiopathic interstitial pneumonias (IIPs): a pictorial review[J]. Insights Imaging, 2014,5(3):347-364.
pmid: 24844883
[16] 李海兰, 熊曾, 刘进康, 等. 结缔组织病相关性肺间质病变的高分辨CT表现[J]. 中南大学学报(医学版), 2017,42(8):934-939.
[17] Oldham JM, Adegunsoye A, Valenzi E, et al. Characterisation of patients with interstitial pneumonia with autoimmune features[J]. Eur Respir J, 2016,47(6):1767-1775.
pmid: 27103387
[18] King TE Jr, Bradford WZ, Castro-Bernardini S, et al. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis[J]. N Engl J Med, 2014,370(22):2083-2092.
pmid: 24836312
[19] Wang T, Zheng XJ, Liang BM, et al. Clinical features of rheumatoid arthritis-associated interstitial lung disease[J]. Sci Rep, 2015,5:14897.
pmid: 26443305
[20] Zhang Y, Li H, Wu N, et al. Retrospective study of the clinical characteristics and risk factors of rheumatoid arthritis-associated interstitial lung disease[J]. Clin Rheumatol, 2017,36(1):817-823.
[21] Hamblin MJ, Horton MR. Rheumatoid arthritis-associated interstitial lung disease: diagnostic dilemma[J]. Pulm Med, 2011,2011:872120. doi: 10.1155/2011/872120.
doi: 10.1155/2011/872120 pmid: 21660199
[22] Mohammad HA, Hassan AA, Osman N, et al. Detection of pulmonary involvement in lupus patients with and without clinical pulmonary symptoms[J]. Egypt J Chest Dis Tuberc, 2014,63(2):463-469.
[23] 刘媛, 郑毅. BTB-cap'n'collar同源异构体1-siRNA对转化生长因子-β1诱导的小鼠肺成纤维细胞中抗氧化因子表达的影响[J]. 中华风湿病学杂志, 2017,21(4):225-230.
[1] Zhihui WU, Mingzhi HU, Qiaoying ZHAO, Fengfeng LV, Jingying ZHANG, Wei ZHANG, Yongfu WANG, Xiaolin SUN, Hui WANG. Immunomodulatory mechanism of umbilical cord mesenchymal stem cells modified by miR-125b-5p in systemic lupus erythematosus [J]. Journal of Peking University (Health Sciences), 2024, 56(5): 860-867.
[2] Zhicun LI, Tianyu WU, Lei LIANG, Yu FAN, Yisen MENG, Qian ZHANG. Risk factors analysis and nomogram model construction of postoperative pathological upgrade of prostate cancer patients with single core positive biopsy [J]. Journal of Peking University (Health Sciences), 2024, 56(5): 896-901.
[3] Ye YAN,Xiaolong LI,Haizhui XIA,Xuehua ZHU,Yuting ZHANG,Fan ZHANG,Ke LIU,Cheng LIU,Lulin MA. Analysis of risk factors for long-term overactive bladder after radical prostatectomy [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 589-593.
[4] Yan CHEN,Kuangmeng LI,Kai HONG,Shudong ZHANG,Jianxing CHENG,Zhongjie ZHENG,Wenhao TANG,Lianming ZHAO,Haitao ZHANG,Hui JIANG,Haocheng LIN. Retrospective study on the impact of penile corpus cavernosum injection test on penile vascular function [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 680-686.
[5] Bo PANG,Tongjun GUO,Xi CHEN,Huaqi GUO,Jiazhang SHI,Juan CHEN,Xinmei WANG,Yaoyan LI,Anqi SHAN,Hengyi YU,Jing HUANG,Naijun TANG,Yan WANG,Xinbiao GUO,Guoxing LI,Shaowei WU. Personal nitrogen oxides exposure levels and related influencing factors in adults over 35 years old in Tianjin and Shanghai [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 700-707.
[6] Jing HE,Zhongze FANG,Ying YANG,Jing LIU,Wenyao MA,Yong HUO,Wei GAO,Yangfeng WU,Gaoqiang XIE. Relationship between lipid metabolism molecules in plasma and carotid atheroscle-rotic plaques, traditional cardiovascular risk factors, and dietary factors [J]. Journal of Peking University (Health Sciences), 2024, 56(4): 722-728.
[7] Shan CAI,Yihang ZHANG,Ziyue CHEN,Yunfe LIU,Jiajia DANG,Di SHI,Jiaxin LI,Tianyu HUANG,Jun MA,Yi SONG. Status and pathways of factors influencing physical activity time among elementary and junior high school students in Beijing [J]. Journal of Peking University (Health Sciences), 2024, 56(3): 403-410.
[8] Zuhong ZHANG,Tianjiao CHEN,Jun MA. Associations between puberty timing and cardiovascular metabolic risk factors among primary and secondary students [J]. Journal of Peking University (Health Sciences), 2024, 56(3): 418-423.
[9] Yuting LIN,Huali WANG,Yu TIAN,Litong GONG,Chun CHANG. Factors influencing cognitive function among the older adults in Beijing [J]. Journal of Peking University (Health Sciences), 2024, 56(3): 456-461.
[10] Jinrong ZHU,Yana ZHAO,Wei HUANG,Weiwei ZHAO,Yue WANG,Song WANG,Chunyan SU. Clinical characteristics of COVID-19 infection in patients undergoing hemodialysis [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 267-272.
[11] Limin REN,Chuchu ZHAO,Yi ZHAO,Huiqiong ZHOU,Liyun ZHANG,Youlian WANG,Lingxun SHEN,Wenqiang FAN,Yang LI,Xiaomei LI,Jibo WANG,Yongjing CHENG,Jiajing PENG,Xiaozhen ZHAO,Miao SHAO,Ru Li. Low disease activity and remission status of systemic lupus erythematosus in a real-world study [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 273-278.
[12] Zhanhong LAI,Jiachen LI,Zelin YUN,Yonggang ZHANG,Hao ZHANG,Xiaoyan XING,Miao SHAO,Yuebo JIN,Naidi WANG,Yimin LI,Yuhui LI,Zhanguo LI. A unicenter real-world study of the correlation factors for complete clinical response in idiopathic inflammatory myopathies [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 284-292.
[13] Xiaoqian SI,Xiujuan ZHAO,Fengxue ZHU,Tianbing WANG. Risk factors for acute respiratory distress syndrome in patients with traumatic hemorrhagic shock [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 307-312.
[14] Yangyang LI,Lin HOU,Zijun MA,Shanyamei HUANG,Jie LIU,Chaomei ZENG,Jiong QIN. Association of pregnancy factors with cow's milk protein allergy in infants [J]. Journal of Peking University (Health Sciences), 2024, 56(1): 144-149.
[15] Xiaoqiang LIU,Yin ZHOU. Risk factors of perioperative hypertension in dental implant surgeries with bone augmentation [J]. Journal of Peking University (Health Sciences), 2024, 56(1): 93-98.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd