系统性红斑狼疮患者淋巴细胞亚群变化与疾病活动的相关性及预测系统损害价值

俞烜华; 张伟桢; 刘昌泉; 吕雪冰; 吴月萍; 陈蓉艳; 黄惠娟

doi:10.16766/j.cnki.issn.1674-4152.004176

系统性红斑狼疮患者淋巴细胞亚群变化与疾病活动的相关性及预测系统损害价值

doi: 10.16766/j.cnki.issn.1674-4152.004176

1.
福建中医药大学附属人民医院风湿病科，福建福州 350004
2.
福建中医药大学第一临床医学院，福建福州 350004
3.
福建中医药大学附属人民医院检验科
4.
福建中医药大学附属人民医院治未病科

基金项目:

福建省自然科学基金项目 2022J01851

福建省卫健委中青年骨干人才项目 2023GGA071

详细信息

通讯作者:
黄惠娟，E-mail：hhj202505@163.com

中图分类号: R593.241
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出版历程
- 收稿日期: 2024-12-22
- 网络出版日期: 2025-11-17

Changes in peripheral blood lymphocyte subsets in patients with systemic lupus erythematosus correlate with disease activity and predict the value of systemic damage

1.
Department of Rheumatology, People' s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350004, China

摘要

摘要: 目的探讨系统性红斑狼疮(SLE)患者淋巴细胞亚群变化与疾病活动的相关性及预测不同系统损害的价值，为评估SLE疾病活动及系统损害提供实验室指标。方法入组2023年3月—2024年6月福建中医药大学附属人民医院收治的SLE患者85例及健康对照80例，SLE以疾病是否活动及不同系统损害等分组，检测各组T淋巴细胞亚群、B淋巴细胞、NK细胞计数，采用相关性分析、logistic回归分析研究各指标与SLE疾病活动指标的相关性及预测不同系统损害的价值。结果 SLE患者及疾病活动组CD3⁺、CD4⁺、CD8⁺T淋巴细胞、B淋巴细胞、NK细胞绝对计数较健康对照组及疾病无活动组均降低；SLE肾脏病变、血液系统受累、关节炎、浆膜炎组CD3⁺、CD4⁺、CD8⁺T淋巴细胞绝对计数较无相应系统损害组均降低；肾脏病变组NK细胞绝对计数降低；合并感染组CD3⁺、CD8⁺T淋巴细胞绝对计数均降低(P < 0.05)。红细胞沉降率(ESR)、抗dsDNA抗体、CD3⁺、CD4⁺、CD8⁺T淋巴细胞绝对计数、NK细胞、B淋巴细胞绝对计数联合检测预测SLE疾病活动的AUC为0.882。补体(C)3、CD3⁺、CD4⁺、CD8⁺T淋巴细胞绝对计数、NK细胞绝对计数预测SLE肾脏病变的AUC为0.833。结论 SLE及疾病活动、不同系统损害、合并感染等组患者淋巴细胞亚群均异常，联合检测淋巴细胞亚群、SLE疾病活动指标可评估SLE疾病活动及预测不同系统损害等。
- 系统性红斑狼疮 /
- 淋巴细胞亚群 /
- 疾病活动 /
- 系统损害
Abstract: Objective To explore the correlation between changes in lymphocyte subsets in systemic lupus erythematosus (SLE) patients and disease activity, as well as the value in predicting different system impairments, in order to provide laboratory indicators for clinical assessment of SLE disease activity and system impairments. Methods A total of 85 SLE patients and 80 healthy controls admitted to People' s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from March 2023 to June 2024 were enrolled. The SLE patients were classified based on disease activity and damage to different systems. The counts of T lymphocyte subsets, B lymphocytes, and NK cells were measured. Correlation analysis and logistic regression analysis were used to explore the correlation between these parameters and SLE disease activity indicators and their predictive value for damage to different systems. Results The absolute counts of CD3⁺, CD4⁺, CD8⁺ T lymphocytes, B lymphocytes, and NK cells in SLE patients and the disease activity group were all lower than those in the healthy control group and the disease inactivity group. The absolute counts of CD3⁺, CD4⁺, and CD8⁺ T lymphocytes in the SLE renal lesion, hematological system involvement, arthritis, and serositis groups were all lower than those in the groups without corresponding system damage. The absolute count of NK cells was decreased in the renal lesion group. The absolute counts of CD3⁺ and CD8⁺ T lymphocytes were decreased in the infection group (P < 0.05). The combined detection of erythrocyte sedimentation rate (ESR), anti-dsDNA antibody, absolute counts of CD3⁺, CD4⁺, and CD8⁺ T lymphocytes, NK cells, and B lymphocytes had an AUC of 0.882 for predicting SLE disease activity. The combined detection of complement (C)3, absolute counts of CD3⁺, CD4⁺, and CD8⁺ T lymphocytes, and NK cells had an AUC of 0.833 for predicting SLE renal lesions. Conclusion Lymphocyte subsets are abnormal in SLE patients with disease activity, damage to different systems, and concomitant infections, etc. Combined detection of lymphocyte subsets and SLE disease activity indicators can assess SLE disease activity and predict damage to different systems.
- Systemic lupus erythematosus /
- Lymphocyte subsets /
- Disease activity /
- System damage

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图 1 各指标预测SLE患者疾病活动的ROC曲线分析

Figure 1. ROC curve analysis of various indicators for predicting disease activity in SLE patients

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图 2 各指标预测SLE患者肾脏病变的ROC曲线分析

Figure 2. ROC curve analysis of various indicators for predicting renal lesions in SLE patients

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图 3 各指标预测SLE患者血液系统受累的ROC曲线分析

Figure 3. ROC curve analysis of various indicators for predicting hematological involvement in SLE patients

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图 4 各指标预测SLE患者关节炎的ROC曲线分析

Figure 4. ROC curve analysis of various indicators for predicting arthritis in SLE patients

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图 5 各指标预测SLE患者浆膜炎的ROC曲线分析

Figure 5. ROC curve analysis of various indicators for predicting serositis in SLE patients

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图 6 各指标预测SLE患者合并感染ROC曲线分析

Figure 6. ROC curve analysis of various indicators for predicting co-infection in SLE patients

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图 7 各指标预测SLE患者使用贝利尤单抗ROC曲线分析

Figure 7. ROC curve analysis of various indicators for predicting the use of belimumab in SLE patients

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图 8 各指标预测SLE患者使用激素剂量ROC曲线分析

Figure 8. ROC curve analysis of various indicators for predicting hormone dosage in SLE patients

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表 1 SLE患者与健康对照组CD3⁺、CD4⁺、CD8⁺T淋巴细胞绝对计数比较[M(P₂₅, P₇₅), 个/μL]

Table 1. Comparison of CD3+, CD4+, CD8+T lymphocyte absolute count between SLE patients and healthy controls[M(P₂₅, P₇₅), /μL]

组别	例数	CD3⁺T淋巴细胞绝对计数	CD4⁺T淋巴细胞绝对计数	CD8⁺T淋巴细胞绝对计数
健康对照组	80	1 663.00(1 199.75，2 064.75)	952.02(698.43，1 181.79)	658.22(483.92，837.61)
SLE	85	1 110.00(917.00，1 475.50)^a	494.00(366.00，693.00)^a	582.00(426.50，725.50)^a
疾病无活动组	27	1 441.00(1 197.00，1 823.00)	676.00(433.00，875.00)	668.00(558.00，909.00)
疾病活动组	58	1 054.00(855.00，1 322.75)^b	425.50(317.00，587.50)^b	509.50(394.75，660.00)^b
SLE-无肾脏病变	53	1 271.00(1 054.00，1 555.00)	523.00(395.00，797.00)	632.00(504.00，865.50)
SLE-肾脏病变	32	913.50(651.75，1236.50)^c	411.50(246.50，580.00)^c	443.00(310.00，621.25)^c
SLE-无血液系统受累	43	1 312.00(1 056.00，1 518.00)	650.00(458.00，806.00)	630.00(513.00，752.00)
SLE-血液系统受累	42	995.00(765.75，1 271.00)^d	400.00(240.75，497.25)^d	478.00(326.50，688.25)^d
SLE-无关节炎	60	1 261.50(1 053.00，1 512.75)	525.50(389.50，778.75)	626.00(477.75，779.75)
SLE-关节炎	25	917.00(588.50，1104.50)^e	414.00(234.50，537.00)^e	430.00(292.50，585.00)^e
SLE-无浆膜炎	75	1 202.00(974.00，1 493.00)	507.00(381.00，722.00)	613.00(463.00，752.00)
SLE-浆膜炎	10	776.50(540.50，1 157.00)^f	296.50(206.00，495.25)^f	378.50(204.75，476.00)^f
SLE-无感染组	73	1 254.00(941.00，1 493.50)	507.00(380.50，736.50)	613.00(444.50，771.50)
SLE-合并感染组	12	951.00(644.50，1 073.25) ^g	373.50(257.50，497.25)	429.50(345.50，582.75) ^g
SLE-无贝利尤单抗组	59	1 083.00(884.00，1 440.00)	512.00(334.00，751.00)	522.00(394.00，635.00)
SLE-贝利尤单抗组	26	1 254.50(1 026.50，1 587.00)	438.50(376.00，594.00)	695.00(548.50，910.25)^h
SLE-低剂量激素组	36	1 107.50(986.75，1 463.50)	512.50 (394.50，737.25)	560.00(476.25，699.50)
SLE-中、高剂量激素组	49	1 110.00(894.50，1 487.00)	433.00(316.00，676.00)	594.00(398.00，833.00)
注：与健康对照组比较，^aP＜0.05；与疾病无活动组比较，^bP＜0.05；与SLE-无肾脏病变比较，^cP＜0.05；与SLE-无血液系统受累比较，^dP＜0.05；与SLE-无关节炎比较，^eP＜0.05；与SLE-无浆膜炎比较，^fP＜0.05；与SLE-无感染组比较，^gP＜0.05；与SLE-无贝利尤单抗组比较，^hP＜0.05。

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表 2 SLE患者与健康对照组B淋巴细胞、NK细胞绝对计数比较[M(P₂₅, P₇₅), 个/μL]

Table 2. Comparison of absolute B-lymphocyte and NK-cell counts in SLE patients and healthy controls[M(P₂₅, P₇₅), /μL]

组别	例数	B淋巴细胞绝对计数	NK细胞绝对计数
健康对照组	80	249.17(182.04，323.22)	394.79(268.70，574.02)
SLE	85	116.00(44.00，191.50)^a	90.50(45.50，140.25)^a
疾病无活动组	27	178.00(97.00，245.00)	119.50(86.75，186.75)
疾病活动组	58	72.50(29.50，156.75)^b	65.50(34.75，128.25)^b
SLE-无肾脏病变	53	116.00(34.50，205.00)	110.00(62.00，165.00)
SLE-肾脏病变	32	110.50(47.00，152.25)	62.00(23.00，105.00)^c
SLE-无血液系统受累	43	116.00(48.00，170.00)	100.50(42.50，175.00)
SLE-血液系统受累	42	104.00 (40.50，197.50)	88.50(54.25，135.75)
SLE-无关节炎	60	103.00(39.00，179.00)	106.47(61.01，155.38)
SLE-关节炎	25	123.50(50.00，232.75)	74.62(29.14，102.41)
SLE-无浆膜炎	75	103.00(42.00，178.00)	99.17(45.70，148.99)
SLE-有浆膜炎	10	158.50(56.75，365.00)	79.11(61.01，111.83)
SLE-无感染组	73	116.00 (42.00，191.00)	94.46(58.07，152.51)
SLE-合并感染组	12	114.00 (63.00，197.50)	80.47(19.48，126.67)
SLE-无贝利尤单抗组	59	121.00(56.75，214.75)	93.00(42.50，146.25)
SLE-贝利尤单抗组	26	42.00(4.00，129.00)^d	87.50 (56.00，129.00)
SLE-低剂量激素组	36	61.00(11.75，117.50)	72.16(22.03，151.19)
SLE-中、高剂量激素组	49	178.00(82.00，244.50)^e	101.67(60.15，146.86)
注：与健康对照组比较，^aP＜0.05；与疾病无活动组比较，^bP＜0.05；与SLE-无肾脏病变比较，^cP＜0.05；与SLE-无贝利尤单抗组比较，^dP＜0.05；与SLE-低剂量激素组比较，^eP＜0.05。

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表 3 SLE患者淋巴细胞亚群水平与疾病活动指标的相关性

Table 3. Correlation between lymphocyte subset levels in SLE patients and disease activity indicators

项目	SLEDAI评分		CD3⁺T淋巴细胞绝对计数		CD4⁺T淋巴细胞绝对计数		CD8⁺T淋巴细胞绝对计数		B淋巴细胞绝对计数		NK细胞绝对计数
项目	r值	P值	r值	P值	r值	P值	r值	P值	r值	P值	r值	P值
ESR	0.275	0.012	-0.290	0.008	-0.364	0.001	-0.191	0.086	-0.222	0.073	-0.112	0.444
CRP	-0.010	0.930	-0.209	0.066	-0.205	0.720	-0.157	0.171	-0.105	0.415	0.095	0.519
C3	-0.230	0.040	0.245	0.028	0.306	0.006	0.138	0.223	0.259	0.039	0.148	0.321
C4	-0.237	0.034	0.293	0.008	0.272	0.014	0.269	0.016	0.348	0.005	0.393	0.006
IgA	0.052	0.644	0.066	0.558	0.204	0.069	-0.018	0.874	0.150	0.236	0.020	0.894
IgM	-0.105	0.352	-0.025	0.826	-0.036	0.750	-0.033	0.770	-0.301	0.016	-0.222	0.133
IgG	0.072	0.524	-0.056	0.622	0.108	0.343	-0.107	0.345	0.226	0.073	-0.383	0.008
抗dsDNA抗体	0.320	0.005	-0.353	0.002	-0.338	0.003	-0.225	0.051	-0.078	0.549	-0.287	0.048
SLEDAI评分			-0.526	< 0.001	-0.467	0.000	-0.389	0.000	-0.260	0.031	-0.414	0.003

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表 4 单因素回归差异有统计学意义的指标评估SLE患者病情的ROC曲线分析

Table 4. ROC curve analysis of factors identified by univariate regression for assessing disease status in SLE patients

SLE分组	指标	AUC(95% CI)	灵敏度(%)	特异度(%)	P值
疾病活动分组	联合检测	0.882(0.785~0.979)	73.5	92.3	< 0.001
肾脏病变分组	联合检测	0.833(0.717~0.949)	94.1	70.0	< 0.001
血液系统受累分组	联合检测	0.765(0.662~0.868)	78.6	69.8	< 0.001
关节炎分组	联合检测	0.775(0.660~0.890)	76.0	70.0	< 0.001
浆膜炎受累分组	联合检测	0.865(0.699~1.000)	75.0	93.7	0.001
感染分组	联合检测	0.792(0.659~0.925)	91.7	60.0	0.001
贝利尤单抗分组	联合检测	0.920(0.847~0.994)	92.9	77.3	< 0.001
激素剂量分组	B淋巴细胞绝对计数	0.808(0.705~0.910)	56.8	96.9	< 0.001

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