الفهرس 
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Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the activation of auto-reactive T and B cells and the production of pathogenic autoantibodies. Dysregulated innate and adaptive immune system responses against self-antigens induce the production of autoantibodies and the deposition of immune complexes in tissues. The disease leads to loss of self-tolerance, multi-organ inflammation and tissue injury. The SLE disease process can inflict widespread damage to multiple organs and systems including the kidneys, skin, cardiovascular, and central nervous systems. Cardiovascular disease (CVD) has profoundly increased the morbidity and mortality of SLE patients. Despite advancements in overall treatment for SLE that have improved prognosis, premature atherosclerosis remains a pernicious comorbid disease, especially among young women. The chronic inflammatory state of SLE is believed to play a crucial role in accelerating atherosclerosis. Over 20 years ago, fatal myocardial infarction has also reported to be 3 times higher in patients with SLE than in gender- and agematched controls. Assessment of the CV disease risk and subclinical atherosclerosis is essential to prevent CV complications by timely treatment in SLE patients . Common carotid intema media thickness (CCIMT) is the most widely used indicator for subclinical atherosclerosis in rheumatic diseases. Increased ccIMT indicates a higher risk of myocardial infarction, peripheral arterial disease, and stroke. 102 • The release of Neutrophil Extracellular Traps, or NETosis, is one of the first defense lines utilized by neutrophils against bacteria, virus, protozoa and other pathogens. It starts with the de-condensation and release of nuclear chromatin outside the cell and leads to the formation of a physical net where pathogens are entrapped and killed by elastase, defensin and reactive oxygen species (ROS). The formation and removal of NETs should be timely regulated and failure to do so may lead to unfavorable consequences. NETosis may be, in particular, implicated in the pathogenesis of autoimmune conditions since DNA and post-translational modified proteins in the NETs may become antigenic . The aim of this study was to evaluate the serum level of neutrophil extracellular traps (NETs) in patients with systemic lupus erythematosus and their association with cardiovascular risk and clinical and laboratory parameters of disease activity. This prospective randomized controlled study was carried out at the department of Rheumatology, Rehabilitation and Physical Medicine, Tanta University Hospitals. • Patients group (n = 40): SLE patients with age varying from 15-50 years old, clinically diagnosed SLE according to the American College of Rheumatology (ACR)/ European League Against Rheumatism (EULAR) 2019 criteria for diagnosis of systemic Lupus erythematosus. •Control group (n = 40): apparently healthy , age and sex matched volunteers . Written informed consent was obtained from all the participants of the study. The study was approved by the Ethics Committee of Faculty of Medicine, Tanta University. All patients were subjected to: Complete history taking, Complete Musculoskeletal examination including assessment of disease activity by SLEDAI Score , complete laboratory investigations including )Antinuclear antibody (ANA) , Anti double stranded DNA antibodies (anti-ds DNA) , Complement C3, and C4 by , ESR , CRP, Complete blood count , Urine analysis , Lipid profile (LDL.HDL, total cholesterol, triglycerides). Neutrophil extracellular trap measurement: by sandwich ELISA, utilizing human MPO ELISA kit. Common Carotid intima media thickness (CIMT) is measured by using a B mode ultrasound. Results: •Regarding demographic data , Comparison between both groups showed insignificant differences (age, sex, BMI). • Regarding SLE- DAI all patients were active with very high activity found in 57.5 % of patients •HB level was significantly higher in control group than in SLE patients , but there was no significant difference between both groups as regard leucocytes and platelets. • ESR (1st hour) and CRP were significantly higher in SLE patients than in control group . •24 hour protein in urine, urine albumin-creatinine ratio and urinary casts were significantly higher in SLE patients than in control group. • ANA, Anti-dsDNA, C3 and C4 were significantly different in SLE patients than in control group. •TC, TG and LDL were significantly higher in SLE patients than control group, while There was no significant difference between either group as regard HDL. •NETs (HMP) level and CIMT were significantly higher in SLE patients than in control group. •There was significant positive relation between NET and disease activity (SLEDAI). •There was significant correlation between NET and duration of the disease, Arthritis, TG and SLEDAI in SLE patients. •There was significant correlation between IMT and age, duration of the disease, TC, NET and SLEDAI in SLE patients.