Qi Wenyi, Zhu Rong, Bai Xue, Luo Ping, Luo Manyu
The Department of Nephropathy, The Second Hospital of Jilin University, Changchun, Jilin, China.
Front Immunol. 2025 Jul 8;16:1613483. doi: 10.3389/fimmu.2025.1613483. eCollection 2025.
The occurrence of lupus nephritis is primarily caused by the dysfunction of the autoimmune system, leading to the deposition of immune complexes (ICs) in the kidneys and associated inflammatory responses. Lymphocyte-related parameters, including the platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and monocyte to lymphocyte ratio (MLR), have been confirmed in recent years as important novel indicators for several inflammatory diseases. However, it remains unclear whether lymphocyte-related parameters can serve as prognostic indicators for lupus nephritis (LN).
This study included a total of 143 LN patients, who were divided into several groups based on the optimal cutoff values of lymphocyte-related parameters. The primary endpoint was poor renal prognosis, and the patients' prognosis was monitored through follow-up, recording the time at which patients reached the study endpoint. The predictive effect was evaluated using the area under the receiver operating characteristic curve (AUROC), Kaplan-Meier (K-M) curves, and Cox proportional hazards analysis.
Compared with the healthy control group, the PLR, NLR, and MLR levels in the LN group were significantly higher (P < 0.05). Kaplan-Meier survival analysis showed that patients with high PLR, NLR, and MLR had poorer prognosis (P < 0.05). Univariate Cox regression analysis indicated that PLR ( 1.002, 95% CI 1.000-1.004, P = 0.05) and NLR ( 1.081, 95% CI 1.031-1.134, P = 0.001) were associated with kidney progression. Multivariate Cox regression analysis showed that only MLR ( 5.861, 95% CI 1.515-22.665, P = 0.010) was an independent risk factor affecting the renal prognosis of LN patients, whereas PLR and NLR were not. Based on the cutoff value of MLR, patients were divided into two groups. In terms of general data, the high MLR group had a significantly higher mean arterial pressure compared to the low MLR group (P = 0.002). In terms of laboratory tests, the high MLR group had a significantly lower eGFR compared to the low MLR group (P = 0.001). In terms of renal pathology, the high MLR group showed statistically significant differences compared to the low MLR group in AI index, CI index, capillary endothelial cell proliferation, cellular/fibrous crescent formation, and interstitial inflammatory cell infiltration (P < 0.05).
MLR may serve as an independent risk factor for poor renal prognosis in SLE patients.
狼疮性肾炎的发生主要是由自身免疫系统功能障碍引起的，导致免疫复合物（ICs）在肾脏中沉积并引发相关炎症反应。近年来，包括血小板与淋巴细胞比值（PLR）、中性粒细胞与淋巴细胞比值（NLR）以及单核细胞与淋巴细胞比值（MLR）在内的淋巴细胞相关参数已被确认为几种炎症性疾病的重要新型指标。然而，淋巴细胞相关参数是否可作为狼疮性肾炎（LN）的预后指标仍不清楚。
本研究共纳入143例LN患者，根据淋巴细胞相关参数的最佳截断值将其分为几组。主要终点是不良肾脏预后，通过随访监测患者的预后情况，记录患者达到研究终点的时间。使用受试者操作特征曲线下面积（AUROC）、Kaplan-Meier（K-M）曲线和Cox比例风险分析评估预测效果。
与健康对照组相比，LN组的PLR、NLR和MLR水平显著更高（P < 0.05）。Kaplan-Meier生存分析表明，PLR、NLR和MLR高的患者预后较差（P < 0.05）。单因素Cox回归分析表明，PLR（1.002，95%CI 1.000 - 1.004，P = 0.05）和NLR（1.081，95%CI 1.031 - 1.134，P = 0.001）与肾脏进展相关。多因素Cox回归分析表明，只有MLR（5.861，95%CI 1.515 - 22.665，P = 0.010）是影响LN患者肾脏预后的独立危险因素，而PLR和NLR不是。根据MLR的截断值，将患者分为两组。在一般数据方面，高MLR组的平均动脉压显著高于低MLR组（P = 0.002）。在实验室检查方面，高MLR组的估算肾小球滤过率（eGFR）显著低于低MLR组（P = 0.001）。在肾脏病理方面，高MLR组与低MLR组在活动指数（AI指数）、慢性指数（CI指数）、毛细血管内皮细胞增殖、细胞性/纤维性新月体形成和间质炎性细胞浸润方面存在统计学显著差异（P < 0.05）。
MLR可能是系统性红斑狼疮（SLE）患者肾脏预后不良的独立危险因素。
