Analysis Of Dyslipidemia And The Correlation With Disease Activity In Patients With Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a more common auto-immune disease in our country .The incidence rate of the disease is 70/10 million. Gender has a great influence on the the disease. The incidence rate of women is higher than the rate of men. The morbidity of female SLE patients who are about 10-year-old is higher than male patients, and the rate is 2:1. The rate is 8:1 in the patients aged from 30~39 years old. Its etiology remains unclear, and maybe be concerned with genetic, sex, environmental factors and so on. Because of the disorder of immune regulatory function, a variety of auto-antibodies based anti-nuclear antibody exist in bodies, and this promotes the formation of immune complexes characterized by auto-immune inflammatory response, with the result that many body systems, multi-organs are injuried. Through clinical and autopsy, people found that patients with systemic lupus erythematosus existed early atherosclerosis, and atherosclerosis had become the complication of SLE. In such patients, cardiovascular and cerebrovascular accidents are two main reasons for death. There are many reasons of abnormal occurrence of hyperlipoproteinemia in systemic lupus erythematosus patients. These influencing factors of lipid metabolism in patients with SLE include disease activity, kidney damage, and the applications of steroid hormone, antihypertensive drugs, immunosuppressive agent and so on.Objective: To compare TC, TG, HDL, LDL level of the group without using steroid hormone, the group using steroid hormone ,the non-hormone group that has renal impairment (All of the three groups patients were first diagnosed SLE) and the heathy controls group in the same period to study the influencing factors of lipid metabolism of SLE patients and to explore the relationships between the lipids change of the group without using steroid hormone and systemic lupus erythematosus disease activity index (SLEDAI), C3, C4.Materials and Methods: The patients with systemic lupus erythematosus in China-Japan union hospital of Jilin university from March 2007 to January 2009. 52 cases of newly diagnosed patients have not used steroid hormone, 41 cases of newly diagnosed patients have used steroid hormone. These cases are in line with the diagnostic criteria which American Society of Rheumatology (ACR) formulated in 1982. The group without using steroid hormone includes 50 women and 2 men cases. The age is from 16-year-old to 63-year-old.The average age is 36±11 years old. The average duration is 12 months (0.5~60 months). The average body mass index (BMI) is 20.38±3.09. All the patients had not used steroid hormone and the drugs such as hydroxychloroquine, immunosuppressive agents. And patients exclude the following:①systemic diseases such as cardio- vascular disease, diabetes, liver disease, other kidney diseases, metabolic diseases;②pregnant women and lactating women;③oral contraceptives and other drugs that affect blood lipids. The group using steroid hormone includes 39 women and 2 men cases. The age is from 11-year-old to 69-year-old.The average age is 36±13 years old. The average duration is 14 months (1~48 months). The average body mass index (BMI) is 20.15±3.01. The hormone dosage before admission is 50±16mg/d. There are 30 cases in normal healthy control group during the same period and excluding cardiovascular disease, diabetes, liver disease, kidney disease and other metabolic diseases. There are 29 female cases, 1 male case. The age is from 14-year-old to 63-year-old. The average age is 37±12 years old. The average body mass index (BMI) is 20.47±3.17. There is no significant difference in the three groups in terms of gender, age, BMI, etc, so they have comparability (P>0.05) (Table 2).Results: The increasing of triglyceride, total cholesterol, low-density lipoprotein cholesterol has a significant difference in the group using steroid hormone and the group without using steroid hormone and the group healthy controls. There is no significant difference of the total cholesterol, low-density lipoprotein of the group without using steroid hormone compared with normal control group, while the two groups has a lower level high density lipoprotein and high triglyceride levels. The high density lipoprotein of the group without using steroid hormone with renal impairment are significantly lower and the triglyceride, low density lipoprotein levels are significantly higher compared with the normal control group. There are 40 cases of lipid disorders in 52 cases of non- hormone therapy group,accounting for 76.9%.And in the cases of lipid increasing accounting for 19.2%(10/52), low density lipoprotein increasing accounting for 17.3%(9/52), high-density lipoprotein lowing accounting for 17.3%(9/52), 23 cases with renal impairment accounting for 44.2%(23/52).And 20 cases exist dyslipidemia in renal impairment group. The renal impairment group has higher triglycerides, low density lipoprotein levels and lower high-density lipoprotein compared with normal control group. The HDL levels and SLEDAI score of the group without using steroid hormone is negatively correlated (r=-0.790, p<0.01). The HDL levels and C3 is positively correlated (r=0.207, p=0.042). The HDL levels and C4 is positively correlated (r=0.685, p<0.01).The TC,TG,LDL levels and SLEDAI score,C3,C4 levels is no significant correlation (p> 0.05) (Table 4 and Figure 2).Conclusion:(1)SLE patients always have hyperlipoproteinemia, mainly showing high triglycerides,high low-density lipoprotein cholesterol and low high-density lipoprotein cholesterol;(2) Steroid hormone is the main factors of dyslipidemia of SLE; (3)The group of SLE patients with renal impairment without using steroid hormone have a higher incidence of dyslipidemia.This indicates that renal impairment can also affect lipid metabolism; (4) In the group without using steroid hormone,serum HDL levels and SLE disease activity(SLEDAI) has a close relationship and serum HDL levels can be used as an indicator of disease activity. Dyslipidemia can promote the development of SLE pathogenetic condition and raise the risk of the early cardiovascular disease, especially the risk of atherosclerosis. Thus, in the therapy of SLE patients and control of disease activity, the reasonable application of steroid hormone, treatment of kidney disease in order to rectify the serum lipid metabolic disorder as soon as possible in patients with SLE have a great significance.