探讨系统性红斑狼疮(SLE)合并肺动脉高压(PH)患者外周血T淋巴细胞亚群水平变化及临床意义。

收集2020年1月至2023年1月在济宁医学院附属医院风湿免疫科住院治疗的121例活动期SLE患者，根据有无肺动脉高压分为PH组(n＝57)与无PH组(n＝64)，检测并比较两组的一般资料、T淋巴细胞亚群(CD3^＋、CD4^＋、CD8^＋、CD4^＋/CD8^＋)。采用Spearman相关性分析T淋巴细胞亚群与SLE患者肺动脉收缩压的相关性，采用二元Logistic回归分析SLE发生PH的影响因素，采用受试者工作特征(ROC)曲线评估相关指标对SLE患者PH的预测价值。

PH组与无PH组在年龄、性别、病程、体重指数、SLE疾病活动指数(SLEDAI)评分比较，均差异无统计学意义(均P>0.05)。PH组CD3^＋T淋巴细胞水平[79.88(71.31，86.60)%]、CD8^＋T淋巴细胞水平[44.61(32.02，59.61)%]高于无PH组CD3^＋T淋巴细胞水平[75.24(66.19，81.60)%]、CD8^＋T淋巴细胞水平[33.17(26.57，40.42)%]，PH组CD4^＋T淋巴细胞水平[31.33(21.25，41.50)%]、CD4^＋/CD8^＋[0.67(0.45，1.17)]低于无PH组CD4^＋T淋巴细胞水平[40.03(29.95，51.26)%]、CD4^＋/CD8^＋比值[1.25(0.84，1.67)]，均差异有统计学意义(Z＝1.99，3.73，3.15，4.03；均P<0.05)。Spearman相关性分析结果显示，SLE患者肺动脉收缩压与CD4^＋T淋巴细胞水平(r＝－0.297)、CD4^＋/CD8^＋(r＝－0.357)呈负相关(均P<0.05)，与CD8^＋T淋巴细胞水平(r＝0.316)呈正相关(P<0.01)。二元Logistic回归分析结果显示，CD8^＋T淋巴细胞水平升高(OR＝1.108，P<0.01)是发生PH的危险因素，CD4^＋T淋巴细胞水平升高(OR＝0.092，P<0.01)是发生PH的保护因素。ROC曲线结果显示，CD3^＋、CD4^＋、CD8^＋T淋巴细胞水平和CD4^＋/CD8^＋以及联合检测预测SLE合并PH的AUC分别为0.605、0.666、0.697、0.713、0.794，均有良好的预测效能(均P<0.05)，其中联合预测效能高于单项。

外周血T淋巴细胞亚群异常与SLE合并PH相关，其对于病情的评估具有较高的价值，可作为一项重要的参考指标，对临床诊治和疾病预后预测有一定的指导意义。

To investigate the changes and clinical significance between the peripheral blood T lymphocyte subsets in systemic lupus erythematosus(SLE) patients with pulmonary hypertension(PH).

A total of 121 active SLE patients diagnosed in Affiliated Hospital of Jining Medical University from January 2020 to January 2023 were selected as the research objects into PH group (n=57) and non-PH group (n=64). The general data and T lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, CD4⁺ /CD8⁺ ) in the 2 groups were detected and compared. The correlation between T lymphocyte subsets and pulmonary artery systolic pressure in SLE patients were analyzed by Spearman′s correlation coefficient, and binary Logistic regression was used to analyse the factors influencing SLE-PH. Receiver operating characteristic(ROC) curve analysis was performed to analyze the predictive value of relevant indicators in these patients.

The general data of PH and non-PH group, such as age, sex, course of disease, BMI and SLEDAI score had no statistically significant difference (all P>0.05). CD3⁺ T lymphocyte level[79.88(71.31, 86.60)%, 75.24(66.19, 81.60)%] and CD8⁺ T lymphocyte level[44.61(32.02, 59.61)%, 33.17(26.57, 40.42)%] were higher in the PH group than those in the non-PH group. CD4⁺ T lymphocyte level[31.33(21.25, 41.50)%, 40.03(29.95, 51.26)%], CD4⁺ /CD8⁺ [0.67(0.45, 1.17), 1.25(0.84, 1.67)] in the PH group were lower than those in the non-PH group, and the differences were statistically significant (Z=1.99, 3.73, 3.15, 4.03, all P<0.05). Spearman correlation analysis showed that the pulmonary artery systolic pressure in SLE patients was negatively correlated with CD4⁺ T lymphocyte level (r=-0.297, P<0.01) and CD4⁺ /CD8⁺ level(r=-0.357, P<0.05), and positively correlated with CD8⁺ T lymphocyte level (r=0.316, P<0.01). Binary Logistic regression analysis showed that high CD8⁺ T lymphocyte level (OR=1.108, P<0.01] was the risk factor for developing PH, and high CD4⁺ T lymphocyte level (OR=0.092, P<0.01) was the protective factor for developing PH. The ROC curve results showed that the AUCs for CD3⁺, CD4⁺, CD8⁺ T lymphocyte level, CD4⁺ /CD8⁺ and the combined test predicted SLE combined with PH were 0.605, 0.666, 0.697, 0.713 and 0.794, respectively, all had good predictive efficacy (all P<0.05), and the combined prediction efficiency was higher than that of single detection.

Abnormal levels of peripheral blood T lymphocyte subsets are associated with SLE combined with PH, which hold significant value for the evaluation of the disease. It can serve as an important reference index, and offer substantial guidance for clinical diagnosis and treatment and disease prognosis prediction.