Clinical Focus ›› 2026, Vol. 41 ›› Issue (2): 140-147.doi: 10.3969/j.issn.1004-583X.2026.02.007

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The role of dynamic lymphocyte subset monitoring in the full-course management of antineutrophil cytoplasmic antibody-associated vasculitis

Zhang Kaidia, Zhang Lijunb, Chen Lua, Xing Guangquna()   

  1. a. Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao 266555, China
    b. Department of Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao 266555, China
  • Received:2025-12-18 Online:2026-02-20 Published:2026-03-05
  • Contact: Xing Guangqun, Email: xinggq@qdu.edu.cn

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Abstract:

Objective To characterize changes in lymphocyte subsets across different disease stages of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and to evaluate their utility throughout the course of treatment. Methods This retrospective study included 70 AAV patients who attended the Affiliated Hospital of Qingdao University between January 1, 2015 and June 30, 2024 and who had lymphocyte-subset testing performed both at initial presentation during active disease and after induction therapy. We analyzed lymphocyte subset profiles and their dynamics during active disease, remission, and episodes of infection, and explored associations with disease activity (BVAS), infection events, and clinical outcomes. Results Compared with initial active presentation, patients at after induction therapy had significantly lower blood CD4+ T-cell counts and lower proportions of natural killer (NK) cells; both parameters were negatively correlated with BVAS (P=0.006 and P<0.001, respectively). Peripheral B-cell proportion was lowered during active disease and correlated positively with BVAS (P<0.001).The active disease phase had the highest infection rate (52.8%), predominantly pulmonary infections (71.4%). Multivariable logistic regression identified age (OR=1.092,95%CI:1.024-1.163, P=0.007), B-cell proportion (OR=1.077, 95%CI: 1.021-1.136, P=0.007), and C-reactive protein (CRP) level (OR=1.069, 95%CI: 1.033-1.107, P<0.001) as independent risk factors for infection in AAV patients. During follow-up, patients presenting with the composite profile of low CD4+ T-cell count, low NK-cell proportion, high B-cell proportion, elevated CRP, and elevated erythrocyte sedimentation rate (ESR) were more likely to experience adverse renal outcomes (P=0.042); this association was confirmed in an independent validation cohort (P=0.014). Conclusion Lymphocyte subset profiling is informative for assessing disease activity and infection susceptibility in AAV. A combined biomarker approach incorporating lymphocyte subsets, ESR, and CRP can help stratify disease status and guide more precise therapeutic decisions.

Key words: anti-neutrophil cytoplasmic antibody-associated vasculitis, lymphocyte subsets, active state, infection, prognosis

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