狼疮性肾炎患者诱导治疗初期的免疫状态与感染风险相关性
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平顶山市第一人民医院肾内科

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The correlation between the immune status at the initial stage of induction therapy and the risk of infection in patients with lupus nephritis
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    目的:检测狼疮性肾炎(LN)诱导治疗前的免疫指标,寻找对LN患者诱导治疗初期感染具有预测价值的指标,以为感染高危患者的筛选及预防性抗感染提供指导。方法:选择2022年1月~2024年12月82例活动性Ⅲ/Ⅳ型LN患者作为研究对象,均于诱导治疗之前检测外周血淋巴细胞、T淋巴细胞亚群及B淋巴细胞亚群。根据诱导治疗初期有无发生感染将其分为感染组(n=39)与未感染组(n=43)。收集两组患者的人口学、病理分型、诱导治疗方案、吗替麦考酚酯(MMF)剂量及基线免疫指标进行分析。结果:感染组与未感染组之间的年龄、性别、体质量指数、病理分型、诱导治疗方案差异均无统计学意义(P均>0. 05),而MMF剂量差异具有统计学意义(P<0.05)。感染组与未感染组CD3+、CD4+及CD8+细胞数、Th1细胞、Th2细胞、Treg细胞及CD19+B差异均无统计学意义(P均>0. 05), 统计学意义(P<0.05)。多因素Logistic回归分析显示,MMF剂量、Th1/Th2比值、Th17/Treg比值是发生感染的独立影响因素(P<0.05)。MMF剂量、Th1/Th2比值、Th17/Treg比值对感染具有中等可靠的预测价值(AUC介于0.7~0.9),三项指标联合的预测价值高(AUC>0.9),敏感度、特异度分别为93.75%、91.55%。结论:与未感染者相比,诱导治疗初期发生感染患者的基线Th1/Th2比值和Th17/Treg比值失衡更显著;诱导治疗之前可结合Th1/Th2比值、Th17/Treg比值、拟用MMF剂量等综合判断LN患者感染风险。

    Abstract:

    Objective: To detect the immune indicators before induction therapy for lupus nephritis (LN), and to identify the indicators with predictive value for the initial infection in LN patients during induction therapy, so as to provide guidance for the screening of high-risk patients with infection and preventive anti-infection. Methods: A total of 82 patients with active type Ⅲ/Ⅳ LN from January 2022 to December 2024 were selected as the research subjects. Peripheral blood lymphocytes, T lymphocyte subsets and B lymphocyte subsets were all detected before induction therapy. According to whether infection occurred in the early stage of induction therapy, they were divided into the infection group (n=39) and the non-infection group (n=43). The demographic, pathological classification, induction treatment regimens, dose of mycophenolate mofetil (MMF), and baseline immune indicators of the two groups of patients were collected for analysis. Results: There were no statistically significant differences in age, gender, body mass index, pathological classification, and induction treatment regimens between the infected group and the non-infected group (P>0.05), while the difference in MMF dose was statistically significant (P<0.05). There was no statistically significant difference in the number of CD3+, CD4+ and CD8+ cells, Th1 cells, Th2 cells, Treg cells and CD19+B between the infection group and the non-infection group (P>0.05). However, the differences in lymphocytes, helper T cell 17 (Th17), the Th1/Th2 ratio, and the Th17/Treg ratio were statistically significant (P<0.05). Multivariate Logistic regression analysis showed that the dose of MMF, the Th1/Th2 ratio, and the Th17/Treg ratio were independent influencing factors for the occurrence of infection (P<0.05). The dose of MMF, the ratio of Th1/Th2, and the ratio of Th17/Treg have moderately reliable predictive values for infection (AUC ranging from 0.7~ 0.9). The combined predictive value of the three indicators is high (AUC >0.9), and the sensitivity and specificity are 93.75% and 91.55%, respectively. Conclusion: Compared with uninfected individuals, the baseline Th1/Th2 ratio and Th17/Treg ratio imbalance in patients with infection in the early stage of induction therapy is more significant; Before induction therapy, the infection risk of LN patients can be comprehensively judged by combining the Th1/Th2 ratio, Th17/Treg ratio, and the proposed dose of MMF, etc.

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尹逢源.狼疮性肾炎患者诱导治疗初期的免疫状态与感染风险相关性[J].四川生理科学杂志,2025,47(9):

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  • 收稿日期:2025-06-05
  • 最后修改日期:2025-06-18
  • 录用日期:2025-06-28
  • 在线发布日期: 2025-09-24
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