Study On The Correlation Between Peripheral Blood T Lymphocyte Subsets And Clinical Features And Prognosis Of Systemic Lupus Erythematosus

Objectives:In this study,clinical data of patients with systemic lupus erythematosus（SLE）were collected to investigate the relationship between the level of peripheral blood T lymphocyte subsets and disease activity and prognosis in SLE patients.It aims to provide an important basis for clinicians in the clinical diagnosis and treatment of SLE.Methods:We retrospectively analyzed the clinical data of 117 cases of SLE hospitalized in our hospital from December 2015 to March 2019.We analyzed the course,age,clinical manifestations and immunological indicators of the patients and relevant conclusions were drawn by statistical methods.Results:（1）Among the 117 SLE patients included,there were 6 males and 111 females,with a male to female ratio of 1:18.5.The patients were aged 17⁷6 years,with an average age of（36.15±12.60）years and a course of disease of 2（12,36）months.117 cases of SLE patients with Blood System involed in 104 cases（88.9%）,arthritis in 60 cases（51.3%）,rash in 55cases（47.0%）,lupus nephritis in 49 cases（41.9%）,alopecia in 39 cases（33.3%）,fever in 29cases（24.8%）,mucosal ulcer in 22 cases（18.8%）,pleurisy in 7 cases（6.0%）,pericarditis in4 cases（5.1%）,gastrointestinal vasculitis in 3 cases（2.6%）,pulmonary interstitial change in 3 patients（2.6%）.（2）Reduction in hemoglobin in 58（55.8%）,leucopenia in 38（36.5%）,and thrombocytopenia in 30（29.7%）SLE patients with systemic involvement.The levels of CD₃⁺T lymphocytes,CD₈⁺T lymphocytes,monocytes,neutrophils and complement C3 in the blood system involvement group were lower than those in the non-blood system involvement group,with statistically significant differences（P<0.05）.The CD₄⁺T lymphocyte count and complement C3 level of patients in the lupus nephritis group were lower than those in the non-lupus nephritis group,and the SLEDAI score of patients in the lupus nephritis group was higher,with statistically significant differences（P<0.05）.The counts of CD₃⁺T lymphocytes,CD₄⁺T lymphocytes and CD₈⁺T lymphocytes,and the levels of complement C3 and C4 were lower in the joint involvement group than in the non-joint involvement group,and the levels of SLEDAI score,blood sedimentation and serum immunoglobulin IgG in SLE patients in the joint involvement group were higher,with statistically significant differences（P<0.05）.The levels of CD₈⁺T lymphocyte count,white blood cell count,neutrophil count,complement C3 and C4 in the skin involvement group were lower than those in the non-skin involvement group,and the scores of SLEDAI in SLE patients in the skin involvement group were higher,with statistically significant differences（P<0.05）.（3）The counts of CD₃⁺T lymphocytes,CD₄⁺T lymphocytes and CD₈⁺T lymphocytes in SLE patients at different stages of disease activity were statistically significant（P<0.05）.The counts of CD₃⁺T lymphocytes and CD₄⁺T lymphocytes in peripheral blood of SLE patients in the severe active phase were lower than those in the stable phase,while the counts of CD₃⁺T lymphocytes in peripheral blood of SLE patients in the moderate active phase were lower than those in the stable phase,with statistically significant differences（P<0.05）.（4）The counts of CD₃⁺T lymphocytes,CD₄⁺T lymphocytes and CD₈⁺T lymphocyte were negatively correlated with SLEDAI score（r=-0.428,P=0.001;r=0.459,P=0.001;r=0.331,P=0.001）.The counts of CD₃⁺T lymphocytes,CD₄⁺T lymphocytes and CD₈⁺T lymphocytes were positively correlated with complement C3 levels（r=0.456,P=0.001;r=0.442,P=0.001;r=0.309,P=0.004）.（5）The counts of CD₃⁺T lymphocytes and CD₄⁺T lymphocytes in baseline SLE patients with poor prognosis were lower than those in the sustained remission group,and the sedimentation rate was higher than that in the sustained remission group,with statistically significant differences（P<0.05）.The CD₄⁺T lymphocyte count in the continuous remission group was higher than the baseline level after 1 year of treatment,and the comparison between the two groups was statistically significant（P<0.001）.The CD₄⁺T lymphocyte count in the poor prognosis group was slightly higher than the baseline level after treatment,and the comparison between the two groups was not statistically significant（P>0.05）.（6）Multivariate regression analysis revealed that decreased CD₄⁺T lymphocytes（OR17.906,95%CI 1.237-25.925,P=0.034）and elevated erythrocyte sedimentation rate（OR1.035,95%CI 1.001-1.069,P=0.042）were independent risk factors for poor prognosis in SLE patients.Conclusion:（1）SLE patients have different degrees of dysregulation of T lymphocyte subsets.Patients with organ involvement are more likely to have decreased levels of CD₃⁺T and CD₄⁺T lymphocytes,which are closely related to SLE activity.（2）Decreased CD₄⁺T lymphocyte count and increased erythrocyte sedimentation rate are independent risk factors for poor prognosis of SLE.