Systemic Lupus Erythematosus Clinical Trial
Official title:
Haematological Indices in Systemic Lupus Erythematosus and Their Association With Disease Activity
The aim of this study is to investigate the value of several hematological indices such as:
- neutrophil-lymphocyte ratio.
- platelet-lymphocyte ratio.
- red blood cell distribution width.
- mean platelet volume (MPV), RDW/platelet ratio.
- neutrophil / C3 ratio.
- All these as biomarkers of activity in systemic lupus erythematosis patients.
Systemic lupus erythematosus (SLE) is a clinically common autoimmune disease characterized by
abnormal immune response to autologous tissue, eventually resulting in systemic disorders and
diverse clinical manifestations of the patients.
The pathogenesis of SLE remains unclear, but environmental triggers and genetic factors
contribute to the destruction of immune tolerance systems, the production of immunological
lymphocytes, antibodies, and inflammatory cytokines.
The clinical manifestations of SLE range from constitutional symptoms, such as fever, sweats,
weight loss, joint pain and skin rashes (including the classic butter fly rash), to more
serious features, including the involvement of the central nervous system and kidneys.
However, to make a clinical diagnosis of SLE, The SLICC criteria require either that a
patient satisfy at least 4 of 17 criteria, including at least 1 of the 11 clinical criteria
and one of the six immunologic criteria, or that the patient has biopsy-proven nephritis
compatible with SLE in the presence of antinuclear antibodies (ANA) or anti-double-stranded
DNA (dsDNA) antibodies. Patients with higher disease activity often present severer damage of
tissues and organs.
SLE is characterized by high heterogeneity, a complex pathophysiology and various clinical
manifestations; thus, no test alone is sufficiently sensitive or specific for diagnosis.
Active and inactive SLE patients were evaluated according to SLE disease activity index
(SLEDAI).There is significant interest in the identification of biomarkers that can predict
SLE and quantify disease activity.
Neutrophils and lymphocytes play major roles in inflammatory processes. Under inflammatory
conditions, neutrophil and lymphocyte counts undergo temporary changes. Neutrophil to
lymphocyte ratio (NLR) is calculated as the absolute count of neutrophils divided by the
absolute count of lymphocytes.
As an index of systemic inflammation, NLR has been identified to be a useful index for the
differential diagnosis or prognostic prediction of diseases. NLR can be calculated easily and
less costly as compared with detection of other inflammatory cytokines that could be used as
biomarkers for inflammatory response or disease activity in SLE patient.
The platelet-to-lymphocyte ratio (PLR), red blood cell distribution width (RDW), and similar
parameters [ eg, neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) ], which
can be easily obtained using peripheral blood parameters, have been regarded as novel,
accurate inflammatory biomarkers in many diseases.
MPV is a biomarker of platelet turnover, whereas platelet activation is a marker of
inflammation. Previous studies have reported that MPV is correlated with the inflammatory
process and disease activity in RA and ankylosing spondylitis, but the relationship between
MPV and SLE remains controversial.
Complement system activation, production and partial deposition of complement fragments, and
subsequent inflammation all play critical roles in the pathogenesis of SLE. During the
complement activation pathway, Complement 3 was at the core position.
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