摘要
目的通过对狼疮性肾炎(LN)患者治疗全程中淋巴细胞亚群及血细胞比值的动态监测,评价其变化特点以及与LN活动度和感染之间的关系。方法回顾性收集青岛大学附属医院2015年1月至2021年4月住院的65例初治LN患者的临床资料。根据系统性红斑狼疮疾病活动度评分表(SLEDAI-2000)评分、疾病发展阶段及用药情况,分为初诊活动期、诱导治疗后、维持治疗期,监测淋巴细胞亚群及血细胞比值在这3个治疗节点的变化规律,评价其与狼疮活动程度、感染事件之间的关系。结果LN患者初发活动时血CD4^(+)T淋巴细胞计数及自然杀伤(NK)细胞比例下降,与SLEDAI-2000评分呈负相关(r=-0.67、-0.33,P<0.01),诱导治疗后上升;B细胞和CD8^(+)T淋巴细胞比例初发活动时升高,与SLEDAI-2000评分呈正相关(r=0.38、0.26,P<0.01),经诱导治疗后明显下降;而中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)及单核细胞/淋巴细胞比值(MLR)在初发活动时均升高,在诱导治疗后均下降,与SLEDAI-2000评分均呈正相关(r=0.34、0.26、0.29,P<0.05)。维持治疗期血CD4^(+)T淋巴细胞计数及比例、NK细胞比例再次下降,与免疫抑制治疗后的感染高发生率(47.20%,17/36)有关,血CD4^(+)T淋巴细胞计数下降到临界值247.50个/μl时,受试者工作特征曲线下面积(AUC)为0.89,预测感染发生的灵敏度和特异度分别为81.25%、87.50%;关注C反应蛋白(CRP)/CD4^(+)T淋巴细胞可以将预测感染的灵敏度提升到94.12%,同时关注CRP和CD4^(+)T淋巴细胞计数可以将预测感染的特异度提升至95.00%。低CD4^(+)T淋巴细胞计数、低NK细胞比例、高B淋巴细胞比例的组合像提示病情高度活动;低CD4^(+)T淋巴细胞计数、低NK细胞比例、低B淋巴细胞比例的组合像提示重度免疫抑制状态。结论LN患者血CD4^(+)T淋巴细胞计数、NK细胞水平低,B淋巴细胞水平高时,LN活动度越高;血CD4^(+)T淋巴细胞计数、NK
Objective To investigate the clinical value of dynamic detection of lymphocyte subsets and blood cell counts in management of patients with lupus nephritis(LN).Methods The clinical data of 65 patients with primary LN admitted in Affiliated Hospital of Qingdao University from January 2015 to April 2021 were retrospectively analyzed.According to the stage of disease progression and medications used,LN patients were classified into primary active phase,post-induction therapy phase,and maintenance therapy phase.The changes in lymphocyte subsets were monitored,and the relationship of lymphocyte subsets and blood cell count ratios with lupus activity and infection events was evaluated.Results The decrease of CD4^(+)T lymphocyte and NK cell counts were negatively correlated with the activity of systemic lupus erythematosus(SLE)(r=-0.67,-0.33,P<0.01),while CD8^(+)T lymphocyte,B cell counts,neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio(PLR),and monocyte/lymphocyte ratio(MLR)were positively correlated with the SLE activity(r=0.38,0.26,0.34,0.26,0.29,P<0.05).The area under ROC curve(AUC)of CD4^(+)T lymphocyte count in predicting the occurrence of infection in LN patients was the highest(0.89);taking 247.50 cell/μl as cutoff value,the sensitivity and specificity were 81.25%and 87.50%,respectively.The combination of CD4^(+)T lymphocyte with CRP increased the predicting value for the occurrence of infection.Conclusion Dynamic detection of blood lymphocyte subsets and blood cell counts can reflect SLE activity and the occurrence of infection in LN patients.Among these indicators the CD4^(+)T lymphocyte has the highest predictive value for the occurrence of infection,and the combination of the CD4^(+)T lymphocyte count with CRP level can further improve the predicting value.
作者
张丽君
公智卿
韩润鸿
田芬
陈丽丽
李靖
亓晓菁
邢广群
Zhang Lijun;Gong Zhiqing;Han Runhong;Tian Fen;Chen Lili;Li Jing;Qi Xiaojing;Xing Guangqun(Department of Nephrology,Affiliated Hospital of Qingdao University,Qingdao 266555,China)
出处
《中华全科医师杂志》
2023年第12期1288-1294,共7页
Chinese Journal of General Practitioners
基金
国家自然科学基金(81770699)
青岛市卫生健康委员会优秀学科带头人培养计划。
关键词
狼疮肾炎
感染
淋巴细胞亚群
血细胞比值
Lupus nephritis
Infection
Lymphocyte subsets
Blood cell ratios
