Objective To investigate the state of Th1/Th2 cytokine imbalance in patients with lupus nephritis (LN) and its role in the pathogenesis. Methods Plasma level of interleukin-18 and interleukin-13 in 18 patients with active LN and 16 normal controls were measured by enzyme-linked immunoadsordent assay (ELISA). IL-18 and IL-13 expression in the renal tissues from 18 patients and 6 normal renal tissues were also detected by immunohistochemical assay. The ratio of plasma and renal IL-18/IL-13 was then calculated. Results Plasma levels and renal expression of IL-13 and IL-18 in patients with LN were increased significantly compared to those of normal controls (P0.05). The ratio of renal IL-18/IL-13 was not significantly different among all types of LN and normal controls. The ratio of plasma IL-18/IL-13 was positively correlated with LN renal tissue activity index (AI), but no correlationship could be found in renal IL-18/IL-13 ratio. Conclusion It seems that the immune disturbance in systemic lupus erythematosus (SLE) can not be simply divided into Th1 predominant and Th2 predominant. It seems far complicated than this Th1/Th2 paradigm. It may be affected by the state of disease activity, the lesion location and the type of pathology.

Objective:To compare the effect and safety of continuous veno-venous hemofiltration (CVVH)+double plasma molecular absorption (DPMA)+hemoperfusion (HP), CVVH+HP, and CVVH+plasma exchange (PE) in treatment of patient with severe wasp stings injury.Methods:Multicenter, historical cohort study and superiority test were used. From July 2020 to October 2022, patients with wasp sting injury and multiple organ damage admitted to the intensive care units (ICU) of five hospitals were consecutively screened and recruited into the CVVH+DPMA+HP group (intervention group). Propensity score matching was used to establish historical cohorts. Patients with severe wasp sting injury who hospitalized from January 2016 to June 2020 in each ICU were collected and matched 1∶1 with the intervention group, and divided into CVVH+HP group and CVVH+PE group according to their actual hemopurification protocols (historical control groups). The primary outcome was the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on days 3 and 7 after initiation of treatment. Secondary outcomes included complications, length of ICU and hospital stays, and all-cause mortality. Multivariate Cox proportional risk regression was used to analyze the prognosis of patients.Results:After propensity score matching, 56 patients in intervention group and each of the two historical control groups were matched successfully. There were no significant differences in age, gender, comorbidities, biochemical test indices and critical illness scores among the groups. After treatment, APACHE Ⅱ score markedly declined in all groups, and the decrease was faster in the intervention group; treatment with DPMA [hazard ratio ( HR) = 1.04, 95% confidence interval (95% CI) was 1.02-1.08, P = 0.00], the decreased levels of body temperature ( HR = 1.02, 95% CI was 1.00-1.03, P = 0.02), serum creatine kinase (CK; HR = 0.98, 95% CI was 0.96-1.00, P = 0.05) and myoglobin (MYO; HR = 2.88, 95% CI was 1.24-6.69, P = 0.01) were independent risk factors for APACHE Ⅱ score decline to the target value (15 scores). There were no significant differences in the incidence of bleeding complications, filter or perfusion thrombosis, blood pressure reduction, catheter-related infection and anaphylaxis among the groups. Conclusion:CVVH+DPMA+HP regimen can significantly reduce the APACHE Ⅱ score of patients with severe wasp sting injury, and the efficacy is superior to CVVH+HP and CVVH+PE regimens, with safety.