重度活动性狼疮性肾炎冲击治疗淋巴细胞亚群及血细胞比值变化

CHANGES OF LYMPHOCYTE SUBSETS AND BLOOD CELL RATIOS IN PATIENTS WITH SEVERE ACTIVE LUPUS NEPHRITIS AFTER STRESS-DOSED GLUCOCORTICOID TREATMENT

目的探讨重度活动性狼疮性肾炎(LN)病人大剂量糖皮质激素(激素)冲击治疗前后淋巴细胞亚群及血细胞比值的变化及其规律。方法重度活动性LN病人17例,在排除感染或充分治疗感染后,规范予以大剂量泼尼松龙冲击治疗。监测冲击治疗前后病人淋巴细胞亚群及血细胞比值的变化,评价淋巴细胞亚群及血细胞比值的特点及其与临床事件之间的关系。结果冲击治疗后血CD4^(+)T淋巴细胞计数、自然杀伤细胞(NK)和T辅助/诱导细胞比例较冲击治疗前升高,B细胞和T抑制/细胞毒细胞比例、中性粒细胞/淋巴细胞比值(NLR)和血小板/淋巴细胞比值(PLR)较冲击治疗前下降,差异均有显著性(Z=-3.25~2.08,P<0.05)。初入院LN合并感染病人活化T感染细胞比例较未感染者升高,差异有显著性(Z=-2.27,P<0.05);控制感染后行激素冲击治疗,感染组的LN病人活化T感染细胞比例高于无感染病人,血CD4^(+)T淋巴细胞计数及T辅助/诱导细胞比例低于未发生感染病人,差异有显著性(Z=-2.30~-1.97,P<0.05)。经冲击治疗后用淋巴细胞亚群各细胞预测感染时,血CD4^(+)T淋巴细胞计数的受试者工作特征曲线下面积(AUC)最高,截断值为253.50×10^(6)/L,其预测LN感染的灵敏度和特异度分别为85.70%、83.30%。结论LN病人冲击治疗后血CD4^(+)T淋巴细胞、NK细胞比例、B细胞及T抑制/细胞毒细胞比例、NLR和PLR均发生变化,且血CD4^(+)T淋巴细胞计数对LN感染有一定的预测价值。

Objective To investigate the changes in lymphocyte subpopulations and blood cell ratios in patients with severe active lupus nephritis(LN)before and after stress dosing of glucocorticoids.Methods Seventeen patients with severe active LN were given standardized stress dosing of prednisolone after excluding infection or receiving sufficient anti-infection treatment.The patients were monitored for lymphocyte subsets and blood cell ratios before and after high-dose prednisolone therapy to analyze the changes of lymphocyte subsets and blood cell ratios as well as the relationship between these parameters and clinical events.Results After prednisolone treatment,blood CD4^(+)T lymphocyte count,natural killer cells(NK)percentage,and helper/inducer T cell percentage were significantly increased,while B cell percentage,suppressor/cytotoxic T cell percentage,neutrophil/lymphocyte ratio(NLR),and platelet/lymphocyte ratio(PLR)were significantly decreased(Z=-3.25 to 2.08,P<0.05).The proportion of activated T cells was significantly higher in patients with LN with infection than in those without infection at admission(Z=-2.27,P<0.05).After prednisolone therapy,the infection group showed a significantly higher activated T cell percentage,a significantly lower CD4^(+)T lymphocyte count,and a significantly lower helper/inducer T cell percentage compared with non-infection group(Z=-2.30 to-1.97,P<0.05).When using lymphocyte subsets to predict infection after prednisolone therapy,blood CD4^(+)T lymphocyte count had the highest area under the receiver operator characteristic curve,with a cut-off value of 253.50×10^(6)/L,sensitivity of 85.70%,and specificity of 83.30%.Conclusion There were changes in blood CD4^(+)T lymphocyte count,the percentages of NK cells,B cells,and suppressor/cytotoxic T cells,NLR,and PLR in patients with LN after stress-dosed glucocorticoid treatment.Blood CD4^(+)T lymphocyte count shows moderate predictive value for infection in LN.