Relationship Between Peripheral Blood Lymphocyte Subsets Expression And Clinicopathology In Patients With IgA Nephropathy

Backgrounds The pathogenesis of Ig A nephropathy has not been fully elucidation,and many studies have confirmed that Ig A nephropathy is an autoimmune disease.The increase of serum polyigal(p Ig Al)and the structural defect of glycosylation(lack of galactose)are important factors leading to the occurrence and development of Ig A nephropathy.Clinical and pathological manifestations are quite different,and the course of disease is variable.From benign to progressive renal failure,clinicians often face great challenges in judging whether the disease progresses.T lymphocyte subsets are the most commonly used clinical indicators of immune status.Mature helper T cells express the surface protein CD4.The main surface marker of cytotoxic T cells is CD8,and both hyperactivity and hypoxia of immune function are unfavorable to the body.The two T cell subsets each have unique functions,and the balance of the immune system is maintained by the interaction of the two large cell subsets,generating a relatively balanced immune response.Abnormalities of CD4+%,CD8+%,and CD4+/CD8+ suggest abnormal immune function.This study investigated the relationship between peripheral blood lymphocyte subsets and clinicopathology in patients with Ig A nephropathy.Objective To investigate the relationship between peripheral blood lymphocyte subsets expression and clinicopathology in patients with Ig A nephropathy.Methods The enrolled cases were from 110 patients diagnosed with Ig A nephropathy by renal biopsy in our hospital from January 2014 to May 2018.Clinical and pathological indicators of each patient were recorded in detail.Oxford classification was used for pathological classification.The age,sex,course of disease and other general information of the patients in this study were statistically analyzed.BD FACSCanto II flow cytometry was used in this study,and all the supporting reagents of BD company were used.The percentage of lymphocyte subsets was detected and analyzed automatically using Multi SET software.The percentages of CD4+ and CD8+T lymphocytes and the changes of CD4+/CD8+ in Ig A nephropathy patients with different Oxford types were compared and observed.And the comparison of clinical indicators and the correlation of clinical immune indicators among different pathological indicators of Ig A nephropathy.Results 1.According to the Oxford classification,the proliferation integral of the mesangium is divided into M0 and M1(M0 0.5,M1 > 0.5).The CD4+% of patients in the M1 group was higher than that in the M0 group(t=3.196,P=0.002),and the CD4+/CD8+ was also higher than that in the M0 group(t=2.618,P= 0.010),but the difference in CD8+% between the M0 and M1 groups was not statistically significant(t=0.293,P=0.770).2.According to the Oxford classification,there was no difference in CD4+% between the two groups of E0 and E1(E0: no,E1: yes).(t=0.846,P=0.399),there was no significant difference in CD8+% between the two groups.(t=1.339,P=0.183),there was no significant difference in CD4+/CD8+ between the two groups.(t=0.070,P=0.945).3.According to the Oxford classification,S0 and S1(S0: no,S1: yes)were divided into S0 and S1(S0: no,S1: yes),and there was no statistically significant difference in CD4+% between the two groups.(t=1.702,P=0.092),there was no statistically significant difference in CD8+% between the two groups.(t=1.023,P=0.309),there was no statistically significant difference in CD4+/CD8+ between the two groups(t=1.963,P=0.052).4.According to the Oxford classification,the areas of interstitial fibrosis or tubule atrophy were divided into T0,T1 and T2 groups(T0:0 ~ 25%,T1:26% ~ 50%,T2 >50%).There was no statistically significant difference in CD8+%(F=2.591,P=0.080)between the three groups.There was statistically significant difference in CD4+%(F=8.005,P=0.001)and CD4+/CD8+(F=10.646,P=0.000)between the three groups,but no statistically significant difference in CD4+% between the T1 and T2 groups.The differences of CD4+/CD8+ between groups T0 and T1,T1 and T2,T0 and T2 were statistically significant.And with the aggravation of the interstitial lesions and dynamic changes.5.According to the Oxford classification,the C0,C1 and C2(C0: no crescent,C1 <25%,C2 > 25%)groups were divided into different cellular or fibrous crescents(C).The differences in CD4+%(F=2.905,P=0.059)and CD8+%(F=1.937,P=0.149)were not statistically significant.The difference of CD4+/CD8+(F=3.340,P=0.039)was statistically significant.However,there was no statistically significant difference in CD4+/CD8+ between C0 and C1 groups.6.The difference of UP at admission was statistically significant in T0,T1 and T2groups(χ2=8.648,P=0.013),and the UP with interstitial fibrosis or tubular atrophy(T)area is increasing,with the development of the MAP on admission to hospital in T0,T1,T2 groups(F = 7.394,P = 0.001)statistically significant differences,SNK test showed that the differences between groups T0 and T1,T1 and T2,T0 and T2 were statistically significant.MAP with interstitial fibrosis or tubular atrophy(T)area is increased with the development of e GFR on admission in T0,T1,T2(F = 25.959,P <0.001)in three group and C0,C1 and C2(F= 0.598,P<0.001)were statistically significant difference between the three groups,The SNK test showed that the differences between groups T0 and T1,T1 and T2,T0 and T2 were statistically significant,and e GFR as interstitial fibrosis or tubular atrophy(T)area is reduced,with the development of SNK test showed that C0,C1 group,The differences between C1 and C2 groups,C0 and C2 groups were statistically significant,which decreased with the increase of the cell or fibrous crescent(C)fraction(P < 0.05).There were no statistically significant differences in UP,MAP and e GFR between M0 and M1,E0 and E1,S0 and S1 at admission.7.In the T0 group,CD4+% was negatively correlated with e GFR(r=-0.387,P=0.003),CD8+% was positively correlated with e GFR(r=0.516,P < 0.001),CD4+/CD8+ was negatively correlated with e GFR(r=-0.771,P< 0.001),and CD8+% was positively correlated with e GFR(r=0.457,P=0.005).CD4+/CD8+ was negatively correlated with e GFR(r=-0.764,P< 0.001),CD4+% was not correlated with e GFR in the T2group(r=-0.166,P=0.510),CD8+% was positively correlated with e GFR in the T2group(r=0.673,P=0.002),and CD4+/CD8+ was negatively correlated with e GFR in the T2 group(r=-0.732,P=0.001).CD4+%,CD8+%,CD4+/CD8+ in T0 group,T1 group and T2 group had no correlation with MAP and UP(P > 0.05).Conclusion 1.Peripheral blood T lymphocyte counts in patients with Ig A nephropathy showed different changes in renal interstitial fibrosis or tubule atrophy,and this change was related to the severity of the disease.2.Peripheral blood T lymphoid subpopulations are associated with clinical indicators of Ig A nephropathy with varying degrees of renal interstitial fibrosis or tubular atrophy.