| Objective To explore the effects of different ages or pathological types on the levels of T lymphocyte subsets and their infection in patients with chronic kidney disease,and to study the value of lymphocyte levels in the diagnosis of infection in patients with chronic kidney disease.Methods A total of 447 patients with chronic kidney disease who were hospitalized in the Department of Nephrology,Inner Mongolia People's Hospital from 2010 to 2014 were collected.Select 165 patients with autoimmune diseases(such as systemic immune lupus erythematosus and vasculitis)who have not been treated with hormones or immunosuppressants for two years before admission.According to the age classification criteria recommended by the WHO,patients were divided into three groups(<45 years,45-59years,?60 years).The type of nephritis depends on the primary disease and pathological type.Bacterial infection standards require the following 5 items to be met at the same time:(1)fever;(2)white blood cell anomalies and the proportion of neutrophils increased;(3)Procalcitonin(PCT)is more significant than 0.1ng/ml;(4)bacteremia or nonbacteremic;(5)have respiratory tract infection or(And)clinical manifestations of urinary tract infections and/or skin infections.All subjects used flow cytometry to measure the absolute counts of peripheral blood CD3~+,CD4~+,and CD8~+T lymphocytes.Results 1.In patients with chronic kidney disease,T-lymphocyte levels gradually decrease,and the infection rate rises with age.2.Among patients with chronic kidney disease,CD3~+,CD4~+,and CD8~+T lymphocyte counts were higher in patients with Ig A nephropathy than in patients with non-Ig A nephropathy.3.Among patients with chronic kidney disease,CD3~+,CD4~+,and CD8~+T lymphocyte counts were higher in patients with membranous nephropathy than in patients with non-membrane nephropathy.4.The CD3~+,CD4~+,and CD8~+T lymphocyte counts of patients with diabetic nephropathy are lower than those of other types of chronic kidney disease.5.The CD3~+,CD4~+,and CD8~+T lymphocyte counts in patients with hypertension and CKD were lower than those in nonhypertensive patients.6.In patients with lupus nephritis(LN),the CD3~+,CD8~+T lymphocyte count,and CD4~+/CD8~+ratio of the low white blood cell group were lower than those of the normal white blood cell group,and there was no significant difference in CD4~+T lymphocytes.7.CD4~+T lymphocyte count is an independent risk factor for infection.According to the above diagnostic criteria for infection,the diagnostic value of CD4~+T lymphocyte count for CKD patients is analyzed by ROC curve.The area under the ROC curve(AUROC)is 0.560,and the cut-off value is 469.Taking the absolute count of CD4~+T of CKD patients as 469 as the cut-off value,the sensitivity and specificity of predicting infection in patients with chronic kidney disease were 36.9%and 73.36%,respectively.Conclusion Age is an independent risk factor that affects the level of T lymphocytes.With the increase of age,the level of T lymphocytes in CKD patients gradually decreases and the infection rate gradually increases.The lymphocytes of primary glomerulonephritis(Ig A nephropathy,membranous nephropathy)in CKD patients Counts are higher than those of other types of CKD patients;Lymphocyte counts of patients with diabetic nephropathy and hypertensive renal damage are lower than those of other types of CKD patients,and the risk of infection in these patients should be valued clinically.There was no significant difference in CD4~+T lymphocytes between patients with normal white blood cells and patients with low white blood cells in patients with lupus nephritis,and there was no significant increase in the risk of infection in patients with low white blood cells;CD4~+T lymphocytes are closely related to infection in patients with CKD.CD4~+T<469 cells/?l has certain reference value for predicting infection in patients with chronic kidney disease. |
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