特发性膜性肾病患者血清 APRIL, MCP-1, CD4+/CD8+ 比值 与免疫抑制剂治疗疗效的关系分析.

Objective: To investigate the relationship between serum aproliferation inducing ligand (APRIL), monocyte chemoattractant protein-1 (MCP-1), CD4+/CD8+ ratio and immunosuppressive therapy efficacy in patients with idiopathic membranous nephropathy (IMN). Methods: 167 IMN patients who received immunosuppressive therapy in Loudi Hospital Affiliated to South China University from January 2020 to March 2022 were selected as the research objects. The levels of serum APRIL and MCP-1 before treatment were detected by enzyme-linked immunosorbent assay (ELISA), CD4+ and CD8+ were detected by flow cytometry, and the ratio of CD4+/CD8+ was calculated. Patients were divided into effective group (n=126) and ineffective group (n=41) according to the curative effect after treatment, the serum APRIL, MCP-1 and CD4+/CD8+ ratio were compared between two groups. The influencing factors of the efficacy of immunosuppressive therapy for IMN were analyzed by Logistic regression model, the predictive value of serum APRIL, MCP-1 and CD4+/CD8+ ratio for ineffective immunosuppressive therapy was analyzed by receiver operating characteristic (ROC) curve. Results: The serum APRIL, MCP-1 and CD4+/CD8+ ratio in ineffective group were higher than those in effective group (P<0.05). Univariate analysis showed that, the efficacy of immunosuppressive therapy in IMN patients was related to pathological stage, 24 h urine protein, serum creatinine (Scr), cystatin C (CysC), and glomerular filtration rate (GFR) (P<0.05). Multivariate Logistic regression analysis showed that, elevated serum APRI, MCP-1, CD4+/CD8+ ratio and pathological stage III and IV were independent risk factors for ineffective immunosuppressive therapy for IMN (P<0.05). The area under the curve (AUC) of serum APRIL, MCP-1, CD4+/CD8+ ratio and combined detection for predicting ineffective immunosuppressive therapy in IMN patients were 0.815, 0.811, 0.749 and 0.939 respectively, the predictive value of combined detection was better than that of each index alone. Conclusion: The increase of serum APRIL, MCP-1 and CD4+/CD8+ ratio are independent risk factors for the ineffective treatment of IMN immunosuppressive agents, the combine detection of the three indicators has a high predictive value for the efficacy of IMN immunosuppressive agents. [ABSTRACT FROM AUTHOR]