Overall, 395 individuals were enrolled in this study, including 154 cases of male, 241 cases of female. In all the cases, there were 79 patients with SLE, 100 patients with LN, 108 patients with nephrotic syndrome (NS) and 108patients with nephritis (including glomerulonephritis and pyelonephritis).
3.1 Test results and comparative analysis between SLE group and LN group
Because of the high probability of lupus nephritis in patients with SLE, we compared the clinical test results of the SLE group and the lupus nephritis group (Table 1). The proportions of sex and age were no significant difference between in the SLE group and the lupus nephritis group. As compared with SLE group, the levels of CHO, LDL-C, Lpa, ApoB and FIB were significantly higher in the lupus nephritis group in blood fatty and coagulative function detection. In liver and renal function biochemical examination, the levels of A/G, BUN, CREA, Cys-C, UA, mALBU and mALBU/UCR were significantly higher in lupus nephritis group than in the SLE group. In lymphocyte subsets examination, the proportion of CD3 + CD4 + CD8+ (DPT cell) was also significantly higher in lupus nephritis group than in the SLE group. There were no significant associations between 2 groups in the levels of TG, HDL-C, ApoA, D-Dimer, hs-CRP, CD3 + CD4 + CD8-, CD3 + CD4-CD8+, CD3 + CD4-CD8-and T4/T8.
Table 1
Clinical test information of the SLE group and the Lupus nephritis group.
Variable
|
SLE (n = 79)
|
Lupus nephritis (n = 100)
|
t/χ2 value
|
P value
|
Male (%)
|
14.10
|
13.00
|
0.035
|
0.852
|
Age (year)
|
36.54±14.15
|
40.82±13.79
|
1.557
|
0.121
|
CHO (mmol/L)
|
4.31±1.21
|
5.07±1.55
|
3.285
|
0.001
|
TG (mmol/L)
|
1.77±2.22
|
1.96±0.96
|
0.703
|
0.483
|
HDL-C (mmol/L)
|
1.44±0.58
|
1.48±0.55
|
0.417
|
0.667
|
LDL-C (mmol/L)
|
2.29±0.82
|
2.79±1.13
|
2.958
|
0.004
|
Lpa
|
170.81±153.08
|
294.15±310.48
|
2.601
|
0.011
|
ApoA
|
1.30±0.36
|
1.34±0.37
|
0.454
|
0.651
|
ApoB
|
0.76±0.30
|
0.90±0.36
|
2.343
|
0.021
|
A/G
|
1.71±0.38
|
1.51±0.44
|
-5.638
|
0.000
|
BUN(mmol/L)
|
4.99±1.57
|
10.16±8.48
|
5.303
|
0.000
|
CREA (umol/L)
|
69.63±23.84
|
135.21±140.41
|
4.076
|
0.000
|
Cys-C (mg/L)
|
0.91±0.26
|
1.87±1.22
|
6.674
|
0.000
|
CCR (ml/min)
|
95.09±19.61
|
64.85±46.88
|
-5.267
|
0.000
|
UA (umol/L)
|
305.15±118.00
|
402.37±162.85
|
4.421
|
0.000
|
mALBU (mg/L)
|
29.04±68.60
|
1819.57±3357.35
|
4.092
|
0.000
|
mALBU/UCR(mg/g)
|
38.44±110.04
|
2400.72±5912.72
|
3.066
|
0.003
|
FIB
|
2.87±0.98
|
3.40±1.23
|
2.717
|
0.007
|
D-Dimer
|
1.85±1.79
|
3.22±6.50
|
1.159
|
0.250
|
hs-CRP (mg/L)
|
0.99 ± 0.98
|
1.45 ± 2.30
|
1.617
|
0.108
|
CD3 + CD4 + CD8-
|
32.59±9.92
|
32.15±8.89
|
-0.315
|
0.753
|
CD3 + CD4-CD8+
|
33.69±11.95
|
37.00±10.50
|
1.968
|
0.051
|
CD3 + CD4 + CD8+
|
0.40±0.35
|
0.84±0.91
|
4.012
|
0.000
|
CD3 + CD4-CD8-
|
3.59±2.85
|
3.55±2.45
|
-0.096
|
0.924
|
T4/T8
|
1.18±0.77
|
0.99±0.60
|
-1.770
|
0.078
|
3.2 The proportion of DPT cells is high risk factor for nephropathy in SLE patients
As shown in Table 2, the proportion of DPT cells was an independent risk factor for nephropathy in SLE patients (odds ratio [OR] 5.136, 95% confidence interval [CI] 2.115 ~ 12.473; P < 0.001) by multivariate logistic regression analysis. Hyperuricemia (OR = 3.285, P = 0.001, 95% CI = 1.597 ~ 6.757) and hypertriglyceridemia (OR = 2.617, P = 0.013, 95% CI = 1.288 ~ 5.577) may also contribute to the deterioration of LN in patients with SLE. No significant associations between any of the other factors (hypercholesterolemia, hyperuricemia, Sex) and nephropathy were observed in SLE patients.
Table 2
Multivariate logistic regression analysis of independent risk factor for renal impairment in systemic lupus erythematosus.
Independent risk factor
|
95% CI
|
P value
|
OR value
|
hypercholesterolemia
|
0.505 ~ 3.742
|
0.534
|
1.375
|
hypertriglyceridemia
|
1.288 ~ 5.577
|
0.013
|
2.617
|
hyperuricemia
|
1.597 ~ 6.757
|
0.001
|
3.285
|
Sex
|
0.264 ~ 2.065
|
0.563
|
0.738
|
CD4 + CD8 + DPT
|
2.115 ~ 12.473
|
0.000
|
5.136
|
3.3 The proportion of DPT cell in LN group is obviously higher than that in NS group
To further determine the impact of DPT cells on the Lupus nephritis development process, we compared the clinical test results of the nephritic syndrome group and the lupus nephritis group (Table 3). The proportions of sex and age were significant difference between in the nephritic syndrome group and the lupus nephritis group. As compared with nephritic syndrome group, the levels of HDL-C, LDL-C, ApoA, ApoB and FIB were significantly lower in the lupus nephritis group in blood fatty and coagulative function detection. In liver and renal function biochemical examination, the level of A/G was higher in lupus nephritis group than in the SLE group, but the levels of hs-CRP and mALBU were higher. In lymphocyte subsets examination, the proportion of CD3 + CD4-CD8+, CD3 + CD4 + CD8 + and T4/T8were also significantly higher in lupus nephritis group than in the SLE group. There were no significant associations between 2 groups in the levels of CHO, TG, Lpa, ApoA, BUN, CREA, Cys-C, CCR, mALBU/UCR, D-Dimer, hs-CRP, CD3 + CD4 + CD8- and CD3 + CD4-CD8-.
Table 3
Clinical test information of the nephritic syndrome group and the Lupus nephritis group.
Variable
|
nephritic syndrome (n = 108)
|
Lupus nephritis (n = 100)
|
t/χ2 value
|
P value
|
Male (%)
|
55.56
|
13.00
|
20.59
|
0.000
|
Age (year)
|
46.45±18.68
|
40.82±13.79
|
-2.895
|
0.004
|
CHO (mmol/L)
|
7.21±3.04
|
5.07±1.55
|
-0.631
|
0.529
|
TG (mmol/L)
|
2.48±1.62
|
1.96±0.96
|
1.336
|
0.183
|
HDL-C (mmol/L)
|
1.81±0.73
|
1.48±0.55
|
-3.250
|
0.001
|
LDL-C (mmol/L)
|
4.18±2.20
|
2.79±1.13
|
-4.82
|
0.000
|
Lpa
|
410.88±392.15
|
294.15±310.48
|
-1.755
|
0.081
|
ApoA
|
1.57±0.63
|
1.34±0.37
|
-2.608
|
0.010
|
ApoB
|
1.37±0.63
|
0.90±0.36
|
-5.182
|
0.000
|
A/G
|
1.29±0.47
|
1.51±0.44
|
2.534
|
0.012
|
BUN(mmol/L)
|
8.91±6.20
|
10.16±8.48
|
1.220
|
0.224
|
CREA (umol/L)
|
109.37±90.96
|
135.21±140.41
|
1.582
|
0.115
|
Cys-C (mg/L)
|
1.63±1.17
|
1.87±1.22
|
1.365
|
0.174
|
CCR (ml/min)
|
66.95±26.19
|
64.85±46.88
|
-0.389
|
0.698
|
UA (umol/L)
|
408.08±122.77
|
402.37±162.85
|
-0.285
|
0.776
|
mALBU (mg/L)
|
5212.46±7287.50
|
1819.57±3357.35
|
-3.793
|
0.000
|
mALBU/UCR(mg/g)
|
3237.29±3670.86
|
2400.72±5912.72
|
-1.138
|
0.257
|
FIB
|
4.18±1.64
|
3.40±1.23
|
-3.282
|
0.001
|
D-Dimer
|
3.31±4.19
|
3.22±6.50
|
-0.092
|
0.927
|
hs-CRP (mg/L)
|
21.15 ± 57.17
|
1.45 ± 2.30
|
-3.373
|
0.001
|
CD3 + CD4 + CD8-
|
34.18±10.47
|
32.15±8.89
|
-0.510
|
0.135
|
CD3 + CD4-CD8+
|
27.58±10.31
|
37.00±10.50
|
6.525
|
0.000
|
CD3 + CD4 + CD8+
|
0.53±0.36
|
0.84±0.91
|
3.240
|
0.001
|
CD3 + CD4-CD8-
|
3.29±2.11
|
3.55±2.45
|
0.816
|
0.415
|
T4/T8
|
1.52±1.03
|
0.99±0.60
|
-4.446
|
0.000
|
3.4 The proportion of DPT cell in LN group is obviously higher than that in nephritis group
To further determine the impact of DPT cells on the Lupus nephritis development process, we compared the clinical test results of the nephritis group and the lupus nephritis group (Table 4). The proportion of sex was significant difference between in the nephritic syndrome group and the lupus nephritis group. In blood fatty and coagulative function detection, there were no significant associations in the nephritis group and the lupus nephritis group. In liver and renal function biochemical examination, the level of BUN and Cys-C was higher in lupus nephritis group than in the nephritis group, and the level of hs-CRP was lower in lupus nephritis group than in the nephritis group. In lymphocyte subsets examination, the proportion of CD3 + CD4-CD8+, CD3 + CD4 + CD8+, CD3 + CD4-CD8- and T4/T8 were significantly higher in lupus nephritis group than in the SLE group. There were no significant associations between 2 groups in the levels of age, CHO, TG, HDL-C, LDL-C, Lpa, ApoA, ApoB, A/G, CCR, UA, mALBU, mALBU/UCR, FIB, D-Dimer and CD3 + CD4 + CD8-.
Table 4
Clinical test information of the nephritis group and the Lupus nephritis group.
Variable
|
nephritis (n = 108)
|
Lupus nephritis (n = 100)
|
t/χ2 value
|
P value
|
Male (%)
|
65.00
|
13.00
|
19.018
|
0.000
|
Age (year)
|
40.85±16.46
|
40.82±13.79
|
-0.377
|
0.707
|
CHO (mmol/L)
|
4.57±1.41
|
5.07±1.55
|
1.630
|
0.106
|
TG (mmol/L)
|
1.64±0.98
|
1.96±0.96
|
1.613
|
0.110
|
HDL-C (mmol/L)
|
1.31±0.39
|
1.48±0.55
|
1.603
|
0.112
|
LDL-C (mmol/L)
|
2.60±1.06
|
2.79±1.13
|
0.856
|
0.394
|
Lpa
|
171.11±136.54
|
294.15±310.48
|
1.834
|
0.070
|
ApoA
|
1.29±0.32
|
1.34±0.37
|
0.557
|
0.579
|
ApoB
|
0.87±0.37
|
0.90±0.36
|
0.430
|
0.668
|
A/G
|
1.57±0.49
|
1.51±0.44
|
-0.668
|
0.505
|
BUN(mmol/L)
|
7.12±6.23
|
10.16±8.48
|
2.058
|
0.042
|
CREA (umol/L)
|
123.38±139.95
|
135.21±140.41
|
0.446
|
0.657
|
Cys-C (mg/L)
|
1.28±0.61
|
1.87±1.22
|
2.763
|
0.007
|
CCR (ml/min)
|
77.23±29.46
|
64.85±46.88
|
-1.477
|
0.142
|
UA (umol/L)
|
354.91±124.35
|
402.37±162.85
|
1.654
|
0.100
|
mALBU (mg/L)
|
1083.72±1485.24
|
1819.57±3357.35
|
1.208
|
0.230
|
mALBU/UCR(mg/g)
|
897.33±1537.22
|
2400.72±5912.72
|
1.437
|
0.154
|
FIB
|
3.57±1.56
|
3.40±1.23
|
-0.598
|
0.551
|
D-Dimer
|
3.86±5.94
|
3.22±6.50
|
-0.352
|
0.726
|
hs-CRP (mg/L)
|
19.24 ± 35.04
|
1.45 ± 2.30
|
-4.975
|
0.000
|
CD3 + CD4 + CD8-
|
34.32±9.74
|
32.15±8.89
|
-1.267
|
0.207
|
CD3 + CD4-CD8+
|
26.02±8.13
|
37.00±10.50
|
5.934
|
0.000
|
CD3 + CD4 + CD8+
|
0.46±0.36
|
0.84±0.91
|
2.579
|
0.011
|
CD3 + CD4-CD8-
|
4.76±3.99
|
3.55±2.45
|
-2.177
|
0.031
|
T4/T8
|
1.53±0.88
|
0.99±0.60
|
-4.137
|
0.000
|
3.5 Individuals’ biochemical and immunologic results difference in different CCR stages
To further illustrate the differences of the above significant indexes in different kidney damage degree, LN, NS and nephritis groups, the trend chart was plotted among the LN, NS and nephritis groups in Fig. 2. We analyzed individuals’ biochemical and immunologic results difference including mALBU/UCR, A/G, CD3 + CD4 + CD8 + cells (DPT cells) and CHO in different CCR stages. The mALBU/UCR values increases with CCR decreases. When CCR < 30, the mALBU/UCR values of NS group were significantly higher than LN group and nephritis group (Fig. 2A). The A/G values decreases with CCR decreases, and there was no significant difference in three groups (Fig. 2B). AS Fig. 2C showed, the proportion of DPT cell in LN group were significantly higher than in NS group and nephritis group. In addition, the proportion of DPT cell increases with CCR decreases. In NS group, the levels of CHO were no significant difference indifferent CCR stages, but the CHO results of NS group were significantly higher than LN group and nephritis group when CCR values over 30. The above results indicate that mALBU/UCR and A/G were highly dependent on kidney damage. In LN group, the proportions of DPT cell increased in Creatinine clearance rate dependent manner. When CCR value range from 30 to 70, the CHO concentration in NS group was significantly higher than in LN group and nephritis group. Besides, the degree of renal injury was positively correlated with the concentration of CHO.
3.6 Comparative analysis and distribution map of CD4 + CD8 + DPT in three groups
There were significant differences between SLE group and LN group by using t-test analysis of the proportion of DPT cell (t = 4.012, p < 0.001). As compared with NS group and nephritis groups, the proportions of DPT cell were significantly higher in the lupus nephritis group (t = 3.240, p = 0.001; t = 2.57, p = 0.011)(Fig. 3).