Background/Purpose:  Systemic lupus erythematosus (SLE) is a kind of chronic and autoimmune disease with variable multi-system involvement of unknown causes, which is characterized by periods of relapsing-remitting course. Inflammation and vascular abnormalities are the main pathological changes. Part of the SLE patients may present with pulmonary artery hypertension (PAH), which can seriously affect the quality of life and eventually lead to death. The etiology and pathogenesis of PAH is affected by many factors which have not yet been fully elucidated. Till now, there is no highly sensitive and specific biomarker for early diagnosis and prognosis for SLE patients with PAH. The aim of this study is to investigate the plasma level of pentraxin 3 (PTX3) and its clinical significance as a potential biomarker in SLE patients.

Methods:  1) In this study, 46 patients with SLE were enrolled. The diagnostic criteria for SLE were based on the American College of Rheumatology (ACR) revised criteria in 1997 or ACR revised SLE classification standards in 2009. All subjects retained serum and plasma samples, and recorded contemporary clinical manifestations and laboratory data, including duration, clinical symptoms and signs, blood-urine- defecate-test, liver and kidney function, blood lipids, erythrocyte sedimentation rate, C-reactive protein, complement series, antinuclear antibodies (ANAs), anti-ds-DNA antibodies, antiphospholipid antibodies and immunoglobulin, SLEDAI and other data. SLE patients were divided into two groups, activity group and no activity group according to the SLEDAI; further, the activity group was divided into three subgroups, mild, moderate and severe group; all patients were measured by the UCG, PASP≥40mmHg was determined SLE-PAH (add up to 26 cases), while PASP <25 mmHg was the SLE-NPAH (20 cases). 2) 21 healthy subjects were selected as controls. All subjects were collected serum and plasma, stored at -80℃. 3) Enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence immunoassay (ECLIA) were used to detect plasma PTX3 level and serum NT-proBNP level, respectively.

Results:  1) The levels of PTX3 and NT-proBNP of SLE group were significantly higher than healthy control group (P=0.007 and 0.013, respectively). 2) Among SLE patients, PTX3 and NT-proBNP levels increased significantly of SLE-PAH group than those of SLE-NPAH (P=0.001 and 0.022, respectively). 3) The expression of PTX3 in activity group was higher than non-active group (P=0.029). There was no significant difference among mild, moderate and severe activity SLE group in the expression of PTX3 (P=0.14). 4) There was no significant correlation between the levels of PTX3 and NT-proBNP in patients with SLE-PAH (r=0.098, P=0.655). 5) In SLE-PAH group, the expression of PTX3 was positively correlated with SLEDAI scores (r=0.350, P=0.017), while negatively correlated with serum albumin (r=-0.327, P=0.018) ；PTX3 has no correlation with CRP (r=0.097, P=0.651), but was positively correlated with CRP by adjusting age and sex (r=0.178, P<0.001). 6) Multiple linear regression analysis showed that SLEDAI sores were independent predictors of PTX3 level. 7) Receiver operating characteristic (ROC) curve demonstrated the plasma PTX3 level more accurately than NT-proBNP in distinguishing SLE-PAH from SLE-NPAH .

Conclusion:  The circulating levels of PTX3 in SLE-PAH were significantly higher, and positively correlated with CRP level, indicating that PTX3 may be involved in SLE-PAH development. PTX3 may be a sensitive biomarker for SLE-PAH diagnosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pentraxin-3-level-positively-correlated-with-pulmonary-arterial-hypertension-in-systemic-lupus-erythematosus-patients/