不同预后疗效的特发性膜性肾病外周血淋巴细胞亚群变化的临床分析

Clinical Analysis of Peripheral Blood Lymphocyte Subsets in Idiopathic Membranous Nephropathy by Different Therapeutic Outcomes

目的:回顾性分析治疗前后特发性膜性肾病(IMN)患者的淋巴细胞亚群计数,初步探索不同淋巴细胞亚群在IMN患者的临床疗效和预后判断中可能的作用。方法:收集我院2019年01月-2022年03月经肾穿刺或者血清学抗磷脂酶A2受体抗体(sPLA2R-Ab)阳性诊断为IMN患者的临床资料,根据患者随访末期有无达到临床缓解,分为缓解组和未缓解组,比较两组之间基线临床指标以及随访前后淋巴细胞亚群计数的差异。并根据患者sPLA2R-Ab是否阳性分别比较淋巴细胞亚群差异。结果:两组患者基线期在性别、年龄、尿蛋白定量、血肌酐、血白蛋白水平等差异均无统计学意义(P>0.05);与缓解组相比,未缓解组表现更高的外周血CD_(4)^(+)淋巴细胞计数及CD_(4)^(+)/CD+8比值,且这种表现在随访末依旧存在(P<0.05)。根据基线sPLA2R-Ab是否阳性进行分组分析发现,两组CD_(4)^(+)计数未缓解组较缓解组均明显升高,差异具有统计学意义(P<0.05)。结论:初步临床观察表明,IMN患者外周血CD_(4)^(+)计数及CD_(4)^(+)/CD+8比值升高,提示这类患者的疗效可能不佳,详细机制有待进一步研究。

Objective:Retrospectively analyzed the counts of lymphocyte subsets in patients with idiopathic membranous nephropathy(IMN),and explored the possible role of different lymphocyte subsets in the clinical efficacy and prognosis of IMN patients.Methods:The baseline clinical data of patients with IMN were collected,diagnosed by renal pathology or serological anti-phospholipase A2 receptor antibody(sPLA2R-Ab)positive in our hospital from January 2019 to March 2022.They were divided into remission group and non-remission group at the end of follow-up.The differences in baseline clinical indicators and lymphocyte subsets before and follow-up were compared between two groups.The differences of lymphocyte subsets betwe two groups were also compared in sPLA2R-Ab positive or not respectively.Results:There were no statistical differences in gender,age,baseline level of urinary protein,serum creatinine and blood albumin between two groups.Level of peripheral blood CD_(4)^(+)lymphocyte and CD_(4)^(+)/CD+8 rate were higher in the non-remission group,and the difference between the two groups was statistically significant(P<0.05).Further subgroup analysis according to whether sPLA2R-Ab positive or not,peripheral blood CD_(4)^(+)lymphocyte count and CD_(4)^(+)/CD+8 rate in patients without remission was higher than that in remission group both in two subgroups(P<0.05).At the end of follow-up,level of CD_(4)^(+)lymphocytes and in the group without remission were still higher than those in remission(P<0.05).Conclusion:Preliminary clinical observations have shown that if peripheral blood CD_(4)^(+)count and CD_(4)^(+)/CD+8 ratio increase in IMN patients,suggesting that these patients may have poor efficacy,and the detailed mechanism needs to be further studied.