Analysis of clinical features and peripheral lymphocyte subsets of systemic lupus erythematosus patients complicated with tuberculosis infection

doi:10.19982/j.issn.1000-6621.20220240

Abstract

Abstract:

Objective: To investigate the clinical features and characteristics of peripheral blood lymphocyte subsets in systemic lupus erythematosus (SLE) patients complicated with tuberculosis infection. Methods: A retrospective study was conducted in 287 SLE patients who were admitted to Shenzhen People’s Hospital and completed the interferon-gamma release assays and lymphocyte subset detection from January 2015 to December 2021. Among them, 30 cases complicated with active tuberculosis, and 16 cases complicated with latent tuberculosis infection (LTBI). According to the ratio of 1∶2 in the group of SLE complicated with active tuberculosis, 60 patients with SLE not infected with Mycobacterium tuberculosis or other pathogens in the same period were selected as the uninfected group. Meanwhile, 40 healthy volunteers who matched the gender and age of the SLE patients complicated with active tuberculosis and completed the detection of lymphocyte subsets from the health screen center of our hospital were selected as the control group. The clinical features, laboratory test results and clinical treatment were collected and analyzed. Results: The duration of tuberculosis in active tuberculosis group was 4.0 (1.0, 8.0) weeks, and mainly complicated with pulmonary tuberculosis alone (17 cases, 56.7%). The duration of SLE in the active tuberculosis group was 54.0 (7.5, 96.0) months, which was significantly shorter than that of the LTBI group (96.0 (72.0, 180.0) months; Z=-2.832, P=0.005), and the proportion of interstitial pneumonia (7 cases, 23.3%) was significantly higher than that in the LTBI group (0.0%; χ²=4.403, P=0.036). Compared with the uninfected group, CD3⁺ T cell count ((766±480) cells/μl vs. (1146±636) cells/μl), CD4⁺ T cell count ((370±278) cells/μl vs. (517±291) cells/μl) and CD8⁺ T cell counts (376 (244, 421) cells/μl vs. 420 (322, 742) cells/μl) in tuberculosis group were significantly decreased, and the difference was statistically significant (t=-2.875, P=0.005; t=-2.298, P=0.024; Z=-2.842, P=0.004, respectively). There was no significant difference in the proportion of lymphocyte subsets in the three groups of SLE patients. Conclusion: Tuberculosis infection in SLE patients were mainly in the lungs. The incidence of interstitial pneumonia in SLE patients complicated with active tuberculosis was higher. In clinical treatment, if there is a decrease in T lymphocytes in SLE patients, especially when CD8⁺ T cells are significantly decreased, we should be alert whether complicated with tuberculosis infection.

Key words: Lupus erythematosus,systemic, Mycobacterium tuberculosis, Disease attributes, Lymphocyte subsets, Retrospective studies

CLC Number:

R593
R52

Xie Jingyi, Zou Ruifeng, Chen Yulan, Chen Yong, Liu Dongzhou, Hong Xiaoping. Analysis of clinical features and peripheral lymphocyte subsets of systemic lupus erythematosus patients complicated with tuberculosis infection[J]. Chinese Journal of Antituberculosis, 2022, 44(9): 911-916. doi: 10.19982/j.issn.1000-6621.20220240

Figures/Tables 3

因素	SLE合并活动性结核病组(30例)	SLE合并LTBI 组(16例)	SLE未合并感染组(60例)	对照组 (40名)	统计检验值	P值
年龄(岁, $x ¯$ ±s)	40.83±12.17	39.06±8.78	39.72±9.22	38.60±10.03	F=0.299	0.826
性别[例/名(构成比,%)]					χ²=0.157	0.984
男性	4(13.3)	2(12.5)	9(15.0)	5(12.5)
女性	26(86.7)	14(87.5)	51(85.0)	35(87.5)
SLE病程[月,M(Q₁,Q₃)]	54.0(7.5,96.0)	96.0(72.0,180.0)	96.0(24.0,147.0)	-	Z=6.832	0.033
糖皮质激素累计使用剂量[g, M(Q₁,Q₃)]	9.06(1.80,17.79)	24.74(6.41,34.98)	18.19(7.30,34.55)	-	Z=5.138	0.077
免疫抑制剂疗程[月,M(Q₁,Q₃)]	18.0(0.5,46.0)	27.0(12.0,66.0)	36.0(0.5,102.0)	-	Z=1.902	0.386
脏器受累[例(构成比,%)]	22(73.3)	12(75.0)	50(83.3)	-	χ²=1.423	0.491
肾脏受累[例(构成比,%)]	10(33.3)	7(43.8)	32(53.3)	-	χ²=3.265	0.195
血液系统受累[例(构成比,%)]	8(26.7)	8(50.0)	21(35.0)	-	χ²=2.501	0.286
间质性肺炎[例(构成比,%)]	7(23.3)	0(0.0)	5(8.3)	-	χ²=6.888	0.032
肺动脉高压[例(构成比,%)]	2(6.7)	1(6.3)	3(5.0)	-	χ²=0.116	0.944
神经系统受累[例(构成比,%)]	2(6.7)	2(12.5)	3(5.0)	-	χ²=1.152	0.562
SLEDAI-2000评分[分,M(Q₁,Q₃)]	4.0(2.0,6.0)	4.0(2.0,6.5)	4.5(2.0,7.3)	-	Z=2.394	0.302
重度活动[例(构成比,%)]	3(10.0)	0(0.0)	1(1.7)	-	χ²=4.564	0.102
中度活动[例(构成比,%)]	2(6.7)	2(12.5)	8(13.3)	-	χ²=0.912	0.634
轻度活动[例(构成比,%)]	4(13.3)	5(31.3)	21(35.0)	-	χ²=4.708	0.095
无活动[例(构成比,%)]	21(70.0)	9(56.3)	30(50.0)	-	χ²=3.258	0.196
hsCRP[mg/L,M(Q₁,Q₃)]	25.95(4.00,48.61)	3.29(1.09,5.00)	1.13(0.49,3.73)	-	Z=23.027	<0.001
ESR[mm/1h,M(Q₁,Q₃)]	46.00(31.00,72.25)	18.50(7.75,35.25)	20.00(7.75,30.25)	-	Z=11.588	0.003
补体3(g/L, $x ¯$ ±s)	0.82±0.38	0.74±0.33	0.73±0.29	-	F=0.879	0.418
补体4[g/L,M(Q₁,Q₃)]	0.16(0.09,0.23)	0.08(0.05,0.13)	0.13(0.07,0.22)	-	Z=3.098	0.212
IgG(g/L, $x ¯$ ±s)	16.32±6.17	13.36±8.47	13.34±5.09	-	F=2.636	0.076

淋巴细胞亚群计数 (个/μl)	SLE合并活动性结核病组(30例)	SLE合并LTBI 组(16例)	SLE未合并感染组(60例)	对照组 (40名)	统计检验值	P值
总淋巴细胞( $x ¯$ ±s)	1051±705	1546±826	1461±744	1949±603	F=9.273	<0.001
CD3⁺ T细胞( $x ¯$ ±s)	766±480	1228±544	1146±636	1424±488	F=8.011	<0.001
CD4⁺ T细胞( $x ¯$ ±s)	370±278	638±378	517±291	827±311	F=14.605	<0.001
CD8⁺ T细胞[M(Q₁,Q₃)]	376(244,421)	439(289,640)	420(322,742)	451(368,582)	Z=10.287	0.016
CD19⁺ B细胞[M(Q₁,Q₃)]	93(30,186)	82(48,154)	140(70,259)	268(157,321)	Z=23.391	<0.001
NK细胞( $x ¯$ ±s)	121±111	105±81	125±125	245±143	F=9.922	<0.001

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淋巴细胞亚群比例 [%,M(Q₁,Q₃)]	SLE合并活动性结核病组(30例)	SLE合并LTBI 组(16例)	SLE未合并感染组(60例)	对照组 (40名)	Z值	P值
CD3⁺ T细胞	74.35(65.50,81.18)	84.70(76.10,89.45)	79.50(71.55,86.08)	73.75(69.22,78.85)	13.948	0.003
CD4⁺ T细胞	31.20(27.10,39.02)	39.20(35.80,45.95)	35.30(27.5,42.58)	42.2(37.78,46.82)	19.566	<0.001
CD8⁺ T细胞	30.45(24.45,43.12)	36.00(21.78,48.42)	35.15(29.72,43.42)	24.25(20.85,30.12)	34.383	<0.001
CD19⁺ B细胞	9.65(6.80,16.72)	6.25(4.58,9.65)	10.70(6.35,16.95)	13.50(9.78,15.92)	8.482	0.037
NK细胞	11.80(5.12,16.95)	5.65(2.80,11.20)	7.00(3.92,10.90)	11.85(7.48.16.70)	19.207	<0.001