Huang Jing, An Qi, Zhang Cai-Lian, He Lan, Wang Lei
Department of Rheumatism and Immunology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.
Department of Pulmonary and Critical Care Medicine, Yan'an University Affiliated Hospital, Yan'an, Shaanxi 716000, P.R. China.
Exp Ther Med. 2022 Jul 27;24(3):595. doi: 10.3892/etm.2022.11531. eCollection 2022 Sep.
Pulmonary arterial hypertension (PAH) is commonly associated with systemic lupus erythematosus (SLE). The present study investigated the relationship between coagulation and changes in lipid parameters in newly-diagnosed patients with SLE in the presence of PAH and whether the coagulation parameters were mediators between lipids and PAH presence. A total of 301 subjects scheduled for new-onset drug-naïve SLE were consecutively enrolled. Baseline data for patients without PAH and with PAH were gathered and compared. Coagulation and lipid parameters were compared across patients without lipid regulating and anticoagulation medications. Multivariable logistic regression model was applied to examine potential predictors of PAH in SLE. The relationships between them were examined using Spearman's correlation analysis. The relationship between coagulation index and lipids with SLE-PAH was evaluated using mediation analysis. Female patients accounted for 88.0% of the 301 subjects, and the average age was 32 years (range, 25-45 years). A total of 40 patients (13.3%) had PAH, and the average pulmonary artery systolic pressure (sPAP) was 55.825±26.67 mmHg. Patients with PAH were older and had higher levels of fibrin/fibrinogen degradation products (FDP), D-dimer, C-reactive protein, lower levels of complement 3, complement 4 and 25-hydroxy vitamin D3 compared with the non-PAH group. Multivariable logistic regression analysis showed that age and D-dimer were independent predictor factors for PAH. Among patients without lipid regulating and anticoagulation medications, patients in the PAH group had higher levels of D-dimer and FDP, and lower low-density lipoprotein (LDL) levels compared with patients without PAH. There was also a positive relationship between sPAP and D-dimer and FDP, and a negative relationship between sPAP and total cholesterol and LDL. Mediation analysis indicated that 25.61% of the effect of low LDL on PAH presence in systemic lupus erythematosus was mediated by D-dimer. Overall, the effect of low LDL on SLE-PAH appeared to be mediated by D-dimer, which mediated 25.61% of this effect.
肺动脉高压（PAH）通常与系统性红斑狼疮（SLE）相关。本研究调查了新诊断的伴有PAH的SLE患者凝血与血脂参数变化之间的关系，以及凝血参数是否为血脂与PAH存在之间的中介因素。共连续纳入301例计划接受初发未用药SLE治疗的受试者。收集并比较了无PAH和有PAH患者的基线数据。比较了未使用调脂和抗凝药物患者的凝血和血脂参数。应用多变量逻辑回归模型来检查SLE中PAH的潜在预测因素。使用Spearman相关分析检查它们之间的关系。使用中介分析评估凝血指标和血脂与SLE-PAH之间的关系。301例受试者中女性患者占88.0%，平均年龄为32岁（范围25-45岁）。共有40例患者（13.3%）患有PAH，平均肺动脉收缩压（sPAP）为55.825±26.67mmHg。与非PAH组相比，PAH患者年龄更大，纤维蛋白/纤维蛋白原降解产物（FDP）水平、D-二聚体水平、C反应蛋白水平更高，补体3、补体4和25-羟基维生素D3水平更低。多变量逻辑回归分析表明，年龄和D-二聚体是PAH的独立预测因素。在未使用调脂和抗凝药物的患者中，与无PAH患者相比，PAH组患者的D-二聚体和FDP水平更高，低密度脂蛋白（LDL）水平更低。sPAP与D-二聚体和FDP之间也存在正相关，sPAP与总胆固醇和LDL之间存在负相关。中介分析表明，低LDL对系统性红斑狼疮中PAH存在的影响有25.61%是由D-二聚体介导的。总体而言，低LDL对SLE-PAH的影响似乎是由D-二聚体介导的，D-二聚体介导了这种影响的25.61%。
