动态监测CD4^+T淋巴细胞计数在狼疮性肾炎患者治疗全过程中的临床价值  

Clinical value of dynamic monitoring of CD4^+T lymphocyte count in treatment of lupus nephritis

作　　者：张铭 李文哲 李莹莹 范明华 邢广群[1] Zhang Ming;Li Wenzhe;Li Yingying;Fan Minghua;Xing Guangqun(Department of Nephrology,Affiliated Hospital of Qingdao University,Qingdao 266555,China;Department of Nephrology,People's Hospital of Rizhao,Rizhao 276800,China)

机构地区：[1]青岛大学附属医院肾病科,山东青岛266555 [2]日照市人民医院肾内科,山东日照276800

出　　处：《临床荟萃》2020年第9期823-828,共6页Clinical Focus

摘　　要：目的动态监测CD4^+T淋巴细胞计数在狼疮性肾炎(LN)患者治疗全过程中的临床价值。方法对初诊为LN并于初诊时及诱导治疗后均检测过CD4^+T淋巴细胞计数的患者38例,监测CD4^+T淋巴细胞计数在LN患者初治、诱导治疗后及维持治疗期3个治疗节点的变化,其中20例于维持治疗期完善了第3次CD4^+T淋巴细胞计数。分析各治疗阶段的CD4^+T淋巴细胞计数与临床、免疫指标及临床感染事件之间的关系。结果初诊时CD4^+T淋巴细胞计数的降低与系统性红斑狼疮(SLE)的活动性呈负相关(P=0.023)。但在维持治疗期再次出现CD4^+T淋巴细胞计数的下降却与免疫抑制和高感染率(70%)有关。ROC曲线分析发现CD4^+T淋巴细胞计数预测感染发生的曲线下面积(AUC)为0.833,预测感染发生的灵敏度为83.3%,特异度为85.7%。在LN患者维持治疗期,56.2%的感染发生在诱导治疗后的6月内,并以肺部感染最常见。结论LN患者初诊时CD4^+T淋巴细胞计数的下降与SLE的活动相关;而在维持治疗期,尤其是诱导治疗后的6个月内,对于CD4^+T淋巴细胞计数再次下降的患者需警惕感染的发生。Objective To detect and evaluate the clinical value of dynamic monitoring of CD4^+T lymphocyte count in the treatment of patients with lupus nephritis(LN).Methods 38 patients with newly diagnosed LN who had measured CD4^+T lymphocyte count at initial diagnosis and after induction therapy were selected as our study subjects.The CD4^+T lymphocyte count at the time of initial diagnosis,after induction therapy and during maintenance therapy were monitored.Among them,20 cases improved the third CD4^+T lymphocyte count during maintenance therapy.The relationship between CD4^+T lymphocyte count and clinical,immune indicators and clinical infection events in each treatment stage was analyzed.Results The decrease of CD4^+T lymphocyte count at initial diagnosis was negatively correlated with the activity of systemic lupus erythematosus(SLE)(P=0.023).However,the relapse of CD4^+T lymphocyte count reductions during maintenance of therapy was associated with immunosuppression and high infection rate(70%).Further statistical analysis CD4^+T lymphocyte count indicates shows that the area under the ROC curve(AUC)was 0.833,which reflect the prediction of infection.The sensitivity and specificity of the prediction of infection were 83.3%and 85.7%respectively.In LN patients during maintenance treatment,56.2%of the infections occurred within 6 months after their induction therapy.Pulmonary infection was the most common.Conclusion The decrease of CD4^+T lymphocyte count in LN patients at initial diagnosis is associated with SLE activity.For the LN patients at the maintenance therapy stage,especially in 6 months after their induction therapy,the renewed decrease of CD4^+T lymphocyte count should be highly valued as a signal of infection occurrence.

关 键 词：狼疮肾炎 CD4阳性T淋巴细胞 感染 

分 类 号：R593.242[医药卫生—内科学]