The risk factors of cerebral small vessel disease in patients with Systemic Lupus Erythematosus

Cerebral small vessel disease (CSVD) imposes a significant burden on patients with systemic lupus erythematosus (SLE) and adversely impacts their health. To identify risk factors for CSVD in SLE patients and evaluate the clinical features of SLE patients with CSVD. Data from SLE patients at Zhong Da Hospital affiliated with Southeast University (Nanjing, Jiangsu Province, China) were retrospectively collected from June 2013 to April 2022. Patients with CSVD were compared with those without brain parenchymal lesions as detected by Magnetic resonance imaging (MRI). Variables between the two groups were analyzed using the independent sample t-test, Mann-Whitney U test, chi-square test, or Fisher’s exact test. Logistic regression analysis was employed to identify risk factors for CSVD. A total of 100 SLE patients were included, of whom 60 had CSVD. Patients with CSVD were significantly older than those in the control group (48.5 vs. 39.5 years; P = 0.001), though gender distribution and disease duration were comparable between the groups. While clinical manifestations did not differ significantly between the groups, SLE patients with CSVD exhibited higher SLEDAI scores (8 vs. 6, P = 0.046). Hypertension was more common in the CSVD group (28.3% vs. 10.0%, P = 0.027). Additionally, the CSVD group demonstrated a higher prevalence of anti-β2GP1 antibody positivity (51.0% vs. 23.1%, P = 0.007), a greater proportion of patients with low C3 levels (78.4% vs. 54.1%, P = 0.015), and prolonged Activated Partial Thromboplastin Time (APTT) (32.7s vs. 31.4s, P = 0.028). Univariate and multivariate logistic regression analyses identified age (OR 1.062, 95% CI 1.010–1.116; P = 0.020), anti-β2GP1 positivity (OR 3.689, 95% CI 1.243–10.950; P = 0.019), and low C3 levels (OR 3.834, 95% CI 1.318–11.159; P = 0.014) as risk factors for CSVD in SLE patients. Our study revealed that SLE patients with CSVD tended to be older and more often presented with hypertension, positive anti-β2GP1 antibodies, lower C3 levels, higher SLEDAI scores, and prolonged APTT. Notably, advanced age, anti-β2GP1 positivity, and low C3 levels emerged as potential risk factors for CSVD development in SLE patients. These findings highlight the importance of these factors in the clinical management of SLE patients at risk of CSVD.