Relationship between Serum NETs,TWEAK,Peripheral Blood CD4+T/CD8+T Ratio and Disease Activity and Renal Prognosis in Patients with Lupus Nephritis
Objective:To investigate the relationship between serum neutrophil extracellular traps(NETs),tumor necrosis factor-like weak inducer of apoptosis(TWEAK),peripheral blood cluster of differentiation(CD)4+T/CD8+T ratio and disease activity and renal prognosis in patients with lupus nephritis(LN).Methods:137 LN patients(LN group)who were admitted to the Department of Nephrol-ogy,Affiliated Hospital of North Sichuan Medical College from August 2021 to August 2022 were selected,patients were divided into mild activity group(52 cases),moderate activity group(45 cases)and severe activity group(40 cases)according to the systemic lupus erythematosus disease activity index(SLEDAI)-2000 score.After 1 years of follow-up,patients were divided into poor prognosis group(43 cases)and good prognosis group(94 cases)according to the occurrence of kidney-related endpoint events,another 76 healthy volun-teers(control group)were selected during the same period.The levels of serum NETs and TWEAK were detected by enzyme-linked im-munosorbent assay,and the proportion of CD4+T/CD8T in peripheral blood was detected by flow cytometry.The correlation between serum NETs,TWEAK,peripheral blood CD4+T/CD8+T and SLEDAI-2000 score in LN patients were analyzed by Spearman correlation analysis,the factors of poor prognosis in LN patients were analyzed by multivariate Logistic regression analysis,the predictive value of serum NETs,TWEAK and peripheral blood CD4 T/CD8+T for poor prognosis in LN patients were analyzed by receiver operating charac-teristic curve.Results:Compared with control group,the levels of serum NETs and TWEAK in LN group were increased,and the periph-eral blood CD4+T/CD8+T was decreased(P＜0.05).The serum NETs and TWEAK in mild activity group,moderate activity group and se-vere activity group increased in turn,and the peripheral blood CD4+T/CD8+T decreased in turn(P＜0.05).SLEDAI-2000 score in LN pa-tients was positively correlated with serum NETs and TWEAK,and negatively correlated with peripheral blood CD4+T/CD8+T(P＜0.05).Chronic kidney disease stage 4,elevated SLEDAI-2000 score,elevated NETs and elevated TWEAK were independent risk factors for poor prognosis in LN patients,increased estimated glomerular filtration rate and elevated CD4+T/CD8+T were independent protective fac-tors(P＜0.05).The area under the curve of serum NETs,TWEAK and peripheral blood CD4+T/CD8+T combined to predict poor prognosis in LN patients was 0.943,which was greater than 0.790,0.788 and 0.799 predicted by serum NETs,TWEAK and peripheral blood CD4+T/CD8+T alone(P＜0.05).Conclusions:The levels of serum NETs and TWEAK in LN patients are increase,and the peripheral blood CD4+T/CD8+T is decrease,which are closely relate to disease activity and poor renal prognosis,serum NETs and TWEAK combine with peripheral blood CD4+T/CD8+T has a high value in predicting renal prognosis in LN patients.
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