Zhang Nianyi, Peng Yu, Li Rongli, Nie Yuxue, Li Jingna, Yang Xinli, Zhang Jialei, Wang Yifei, Luo Qinhuan, Zhou Jiaxin, Fei Yunyun, Li Mengtao, Peng Linyi, Zhang Wen
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.
Clin Exp Med. 2025 Jun 9;25(1):193. doi: 10.1007/s10238-025-01741-9.
To investigate the clinical significance of leukocyte-to-lymphocyte ratios, particularly the eosinophil-to-lymphocyte ratio (ELR) and basophil-to-lymphocyte ratio (BLR), in IgG4-related disease (IgG4-RD). We enrolled 541 treatment-naïve IgG4-RD patients and compared their ELR, BLR, neutrophil-to-lymphocyte ratio (NLR), and monocyte-to-lymphocyte ratio (MLR) with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and primary Sjögren's syndrome (pSS) patients. K-means cluster analysis was performed to categorize enrolled IgG4-RD patients based on inflammatory markers (ELR, BLR, NLR, Complement 3, Complement 4, erythrocyte sedimentation rate), and clinical data of different clusters were analyzed using statistical methods including Kaplan-Meier curves and Cox regression. ELR and BLR levels were significantly elevated in IgG4-RD patients (ELR: 0.11 [0.05-0.22]; BLR: 0.02 [0.01-0.03]) compared to SLE, RA, and pSS patients (all P < 0.001). ELR was strongly associated with higher disease activity, increased serum IgG4, the number of affected organs, and proliferative phenotype proportions in IgG4-RD patients. We identified a high-risk subgroup of IgG4-RD patients with high ELR/BLR and low complement 3/4 (C3/C4) through clustering analysis. This subgroup exhibited higher disease activity and relapse risk. And IgG4-RD patients with high ELR (≥ 0.1103) had higher relapse rates during follow-up (HR = 2.12, 95% CI 1.37-3.26, P = 0.0005). ELR was identified as a risk factor for relapse in IgG4-RD patients. Our study indicated that the significantly elevated ELR reflects Th2 immune dysregulation and disease severity in IgG4-RD and serves as an independent predictor of relapse, offering a potential biomarker for personalized management.
为了研究白细胞与淋巴细胞比值，尤其是嗜酸性粒细胞与淋巴细胞比值（ELR）和嗜碱性粒细胞与淋巴细胞比值（BLR）在IgG4相关性疾病（IgG4-RD）中的临床意义。我们纳入了541例未经治疗的IgG4-RD患者，并将他们的ELR、BLR、中性粒细胞与淋巴细胞比值（NLR）和单核细胞与淋巴细胞比值（MLR）与系统性红斑狼疮（SLE）、类风湿关节炎（RA）和原发性干燥综合征（pSS）患者进行比较。采用K均值聚类分析，根据炎症标志物（ELR、BLR、NLR、补体3、补体4、红细胞沉降率）对纳入的IgG4-RD患者进行分类，并使用包括Kaplan-Meier曲线和Cox回归在内的统计方法分析不同聚类的临床数据。与SLE、RA和pSS患者相比，IgG4-RD患者的ELR和BLR水平显著升高（ELR：0.11[0.05-0.22]；BLR：0.02[0.01-0.03]）（所有P<0.001）。ELR与IgG4-RD患者较高的疾病活动度、血清IgG4升高、受累器官数量以及增殖表型比例密切相关。通过聚类分析，我们确定了一个ELR/BLR高且补体3/4（C3/C4）低的IgG4-RD患者高危亚组。该亚组表现出更高的疾病活动度和复发风险。ELR高（≥0.1103）的IgG4-RD患者在随访期间复发率更高（HR=2.12，95%CI 1.37-3.26，P=0.0005）。ELR被确定为IgG4-RD患者复发的危险因素。我们的研究表明，ELR显著升高反映了IgG4-RD中Th2免疫失调和疾病严重程度，并作为复发的独立预测指标，为个性化管理提供了一个潜在的生物标志物。
