Liu Chin, Lu Jeng-Wei, Liu Hsiao-Chen, Ho Yi-Jung, Wang Kuang-Yih, Liu Feng-Cheng
Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, Taiwan, R.O.C.
In Vivo. 2025 Sep-Oct;39(5):3025-3036. doi: 10.21873/invivo.14104.
BACKGROUND/AIM: Systemic lupus erythematosus (SLE) is an autoimmune disorder that leads to immune dysregulation and increased infection risk, especially with immunosuppressive therapies and surgical interventions like splenectomy. Immune monitoring in these patients is important. This case report aims to describe the immune changes in an SLE patient, who had received splenectomy, with infective endocarditis (IE) undergoing valve replacement surgery, focusing on immune cell dynamics and exhaustion markers.
A 42-year-old Taiwanese man with SLE and recent splenectomy was diagnosed with IE caused by Staphylococcus aureus, requiring mitral valve replacement surgery. Immune profiling between infection and recover phase showed immune regulation and reconstruction with increased exhaustion markers (killer cell lectin-like receptor subfamily G member 1 (KLRG1), T-cell immunoglobulin and mucin-domain containing-3 (Tim-3), programmed cell death protein 1 (PD-1)) in T cells, expanded regulatory T cells, increased plasmablasts, and decreased regulatory B cells.
SLE leads to significant immune dysregulation, making patients more susceptible to infections, especially when combined with immunosuppressive therapy. This case demonstrates dynamic changes in immune markers, such as KLRG1, Tim-3, and PD-1, following infection and surgery, highlighting the necessary for monitoring of immune function in SLE patients. Changes in T and B cell component emphasize the importance of tailored treatment strategies to keep immune imbalances in these patients. Ongoing research into immune tolerance and exhaustion mechanisms will be crucial for improving therapeutic outcomes in SLE.
背景/目的：系统性红斑狼疮（SLE）是一种自身免疫性疾病，可导致免疫失调并增加感染风险，尤其是在接受免疫抑制治疗和脾切除术等外科手术干预时。对这些患者进行免疫监测很重要。本病例报告旨在描述一名接受脾切除术后并发感染性心内膜炎（IE）并接受瓣膜置换手术的SLE患者的免疫变化，重点关注免疫细胞动态和耗竭标志物。
一名42岁患有SLE且近期接受脾切除术的台湾男性被诊断为金黄色葡萄球菌引起的IE，需要进行二尖瓣置换手术。感染期和恢复期的免疫谱分析显示，T细胞存在免疫调节和重建，伴有耗竭标志物（杀伤细胞凝集素样受体亚家族G成员1（KLRG1）、含T细胞免疫球蛋白和粘蛋白结构域3（Tim-3）、程序性细胞死亡蛋白1（PD-1））增加、调节性T细胞扩增、浆母细胞增多以及调节性B细胞减少。
SLE导致显著的免疫失调，使患者更容易感染，尤其是在联合免疫抑制治疗时。本病例展示了感染和手术后免疫标志物（如KLRG1、Tim-3和PD-1）的动态变化，凸显了监测SLE患者免疫功能的必要性。T和B细胞成分的变化强调了制定个性化治疗策略以维持这些患者免疫平衡的重要性。对免疫耐受和耗竭机制的持续研究对于改善SLE的治疗效果至关重要。
