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

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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)

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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
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