ABSTRACT
The present study was designed to evaluate the frequency of anemia of chronic diseases [ACD] in patients with systemic lupus erythematosus [SLE] and to estimate serum levels of interleukin-6 [IL-6] and erythropotien [EPO] and to determine the serum positivity for antibodies to human EPO [anti-EPO antibodies] in patients with ACD so as to evaluate their probable role in pathogenesis of ACD. The study included 200 patients with SLE; all underwent clinical evaluation of disease activity using the British Isles Lupus Assessment Group [BILAG] score and laboratory assessment of immunologic parameters. Hemoglobin concentration [Hb cone.] was determined and anemia was defined by haemoglobin concentration [Hb cone.] of = 12 g/dl for women and of = 13.5 g/dl for men. Blood samples were obtained for ELISA estimation of serum IL-6 and EPO levels and for El.ISA testing for anti-EPO antibodies. Hemogram detected 73 ACD patients [36.5%] with mean Hb cone, of 10.5 +/- 0.8 gm/dl [Anemic group]; the other 127 patients [63.5%] were either not anemic or had other types of anemia [Non-anemic group] with mean Hb cone, of 12.9 +/- 0.5 gm/dl. There was a negative significant correlation between Hb Cone, and hematological activity score. Mean serum IL-6 estimated in patients with SLE was 53.9 +/- 19.9 ng/ml and was significantly [p < 0.05] higher compared to control levels. Moreover, mean serum IL-6 estimated in anemic group [60.9 +/- 23.1 ng/ml] was significantly [p < 0.05] higher compared both to control and non-anemic groups [49.8 +/- 16.5 ng/ml], with a significantly higher [p < 0.05] levels of serum IL-6 in non-anemic SLE patients compared to controls. Mean serum EPO estimated in patients with SLE was 21.2 +/- 12.1 mlU/ml and anti-EPO antibodies [Anti-EPO Positive] were detected in 105 patients [52.5%] while the other 95 patients [47.5%] were negative for anti-EPO antibodies [Anti-EPO Negative]. Mean serum EPO level was significantly [p < 0.05] lower in Anti-EPO Negative patients [14.4 +/- 2 mlU/ml] compared to Anti-EPO Positive patients [28.7 +/- 14 mIU/ml]. Mean serum EPO level was significantly [p < 0.05] higher in anemic [28.9 +/- 16.8 mlU/ml] compared to non-anemic patients [16.7 +/- 3.8 mIU/ml]. There was a negative significant correlation [r = -0.332, p < 0.001] between presence of Anti-EPO antibodies and Hb cone.; however, there was a non-significant difference between Hb cone, between anemic patients with and without anti-EPO antibodies or between non-anemic patients with and without anti-EPO antibodies. There was a negative significant correlation between Hb cone, and serum EPO, [r = -0.256, p = 0.028] and IL-6, [r = -0.246, p = 0.036] and a positive, significant correlation between serum IL-6 and EPO, [r = 0.238, p = 0.043]. Evaluation of specificity of estimated parameters for pathogenesis of SLE-induced anemia using the receiver operating characteristic [ROC] curve analysis judged by the area under the curve [AUC] defined IL-6 as the most specific factor [AU/C = 0.827], followed by positivity for anti-EPO [AUC = 0.662] and the least specific was EPO [AUC = 0.588]. It could be concluded that the frequency of SLE-induced anemia of chronic disease was 36.5% and the presence of anti-EPO antibodies and elevated IL-6 play a complementary role in its pathogenesis
Subject(s)
Humans , Male , Female , Anemia , Chronic Disease , Interleukin-6/blood , Erythropoietin/blood , Antibodies , Complement C3/immunology , Complement C4/immunologyABSTRACT
Inflammatory response in the atherosclerotic lesions of coronary artery disease, mediated by cellular immune mechanisms is well appreciated. The significance of the immuno-inflammatory processes for the development of acute ischaemic sequelae of these lesions remains unsettled. Fifty patients of acute coronary syndromes were studied for complement components and immunoglobin levels by single radial immunodiffusion method. Twenty-eight patients of acute myocardial infarction showed significantly lower levels of complement components C3 and C4 at admission (C3--69.19 +/- 12.91 mg% compared to 82.40 +/- 9.26 mg% in controls, p < 0.01; C4--14.56 +/- 2.46 mg% compared to 18.53 +/- 2.69 mg% in controls, p < 0.01). Twenty-two patients of unstable angina did not show any significant change (C3--83.14 +/- 8.01 mg% and C4--19.07 +/- 4.47 mg%). Sixteen patients of acute myocardial infarction who were thrombolysed with streptokinase showed a steep rise in the levels of complement components immediately after thrombolysis (C3--69.19 +/- 12.91 mg% before and 100.56 +/- 17.09 mg% after thrombolysis, p < 0.001; C4--14.56 +/- 2.46 mg% before and 21.48 +/- 4.78 mg% after thrombolysis, p < 0.001). Plasma C3 and C4 levels in acute myocardial infarction showed no relationship with peak CPK levels. Plasma immunoglobulins remained unchanged in patients of acute coronary syndromes.