【摘要】 目的 分析抗中性粒细胞胞浆抗体相关性血管炎(antineutrophil cytoplasmic antibody associated vasculitis, AAV)患者在不同疾病阶段淋巴细胞亚群的变化特征，发现并评价其在AAV患者治疗全过程中的价值。方法 纳入2015年1月1日-2024年6月30日于青岛大学附属医院就诊，在疾病初诊活动期及诱导治疗后均检测过淋巴细胞亚群的AAV患者70例，分析AAV患者活动期、缓解期和感染时淋巴细胞亚群的特点及变化规律，发现并评价其与AAV患者活动度、感染事件以及预后的内在联系。结果 与初诊活动期相比，诱导治疗后AAV患者血CD4~+T淋巴细胞计数和自然杀伤细胞比例均上升，且与伯明翰血管炎活度评分呈负相关(P=0.006,P<0.001),同时血B淋巴细胞比例下降，与伯明翰血管炎活度评分呈正相关(P<0.001)。AAV活动期最易感染，发生率高达52.8%,以肺部感染为主(71.4%)。多因素logistic回归分析显示年龄(OR=1.092,95%CI:1.024～1.163,P=0.007)、B淋巴细胞比例(OR=1.077,95%CI:1.021～1.136,P=0.007)和C-反应蛋白(OR=1.069,95%CI:1.033～1.107,P<0.001)是AAV患者发生感染的独立危险因素。持续随访发现，就诊时为低CD4~+T淋巴细胞计数、低自然杀伤细胞比例、高B淋巴细胞比例、高C-反应蛋白水平、高红细胞沉降率的组合像的患者与肾脏不良结局相关(P=0.042);并且在验证集中得到了相同的结果(P=0.014)。结论 淋巴细胞亚群可用于判断AAV患者病情活动状态及感染易感状态，运用淋巴细胞亚群、红细胞沉降率及C-反应蛋白的联动组合可以判断AAV患者病情，精准施治。更多还原

【Abstract】 Objective To characterize changes in lymphocyte subsets across different disease stages of antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV) and to evaluate their utility throughout the course of treatment.Methods This retrospective study included 70 AAV patients who attended the Affiliated Hospital of Qingdao University between January 1, 2015 and June 30, 2024 and who had lymphocyte-subset testing performed both at initial presentation during active disease and after induction therapy. We analyzed lymphocyte subset profiles and their dynamics during active disease, remission, and episodes of infection, and explored associations with disease activity(BVAS), infection events, and clinical outcomes. Results Compared with initial active presentation, patients at after induction therapy had significantly lower blood CD4~+ T-cell counts and lower proportions of natural killer(NK) cells; both parameters were negatively correlated with BVAS(P=0.006 and P<0.001, respectively). Peripheral B-cell proportion was lowered during active disease and correlated positively with BVAS(P<0.001).The active disease phase had the highest infection rate(52.8%), predominantly pulmonary infections(71.4%). Multivariable logistic regression identified age(OR=1.092,95%CI:1.024-1.163, P=0.007), B-cell proportion(OR=1.077, 95%CI: 1.021-1.136, P=0.007), and C-reactive protein(CRP) level(OR=1.069, 95%CI: 1.033-1.107, P<0.001) as independent risk factors for infection in AAV patients. During follow-up, patients presenting with the composite profile of low CD4~+ T-cell count, low NK-cell proportion, high B-cell proportion, elevated CRP, and elevated erythrocyte sedimentation rate(ESR) were more likely to experience adverse renal outcomes(P=0.042); this association was confirmed in an independent validation cohort(P=0.014). Conclusion Lymphocyte subset profiling is informative for assessing disease activity and infection susceptibility in AAV. A combined biomarker approach incorporating lymphocyte subsets, ESR, and CRP can help stratify disease status and guide more precise therapeutic decisions.更多还原