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

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。

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

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.