血清M型磷酸酯酶A2受体联合肾组织IgG 4的检测对成人特发性膜性肾病的诊断价值及临床意义

Diagnostic value and clinical significance of detecting serum M-type phosphatase A2 receptor combined with renal tissue IgG 4 in adults with idiopathic membranous nephropathy

目的探讨血清M型磷酸酯酶A2受体(PLA2R)联合肾组织免疫球蛋白4(IgG 4)的检测对成人特发性膜性肾病(IMN)的诊断价值及临床意义。方法回顾性收集2017年4月~2019年4月新余市人民医院收治的70例膜性肾病患者的临床资料,依据发病原因分为IMN组(30例)与继发性膜性肾病(SMN)组(40例)。所有患者均接受血清PLA2R、肾组织IgG 4检测,分析血清PLA2R联合肾组织IgG 4检测对IMN的诊断价值。结果IMN组血清PLA2R水平高于SMN组,差异有统计学意义(P<0.05)。将血清PLA2R水平作为检验变量,IMN疾病发生情况作为因变量(1=IMN,0=SMN),绘制ROC曲线,以血清PLA2R为25.641 RU/mL作为IMN发生的诊断阈值,即血清PLA2R>25.641 RU/mL则判定为IMN,此时诊断AUC为0.919(P<0.05)。血清PLA2R、肾组织IgG 4联合检测对IMN的诊断准确率为93.33%,高于血清PLA2R、肾组织IgG 4单独检测(均为80.00%),差异有统计学意义(P<0.05);血清PLA2R、肾组织IgG 4水平单独检查IMN与肾活检具有理想的一致性(Kappa=0.622,0.706);联合检查IMN与肾活检具有极好的一致性(Kappa=0.912)。结论血清PLA2R联合肾组织IgG 4的检测对IMN疾病具有较高的诊断价值,临床可根据血清PLA2R联合肾组织IgG 4水平检测结果,及时制定针对性的预防措施。

Objective To investigate the diagnostic value and clinical significance of detecting serum M-type phosphatase A2 receptor(PLA2R)combined with renal tissue immunoglobulin 4(IgG 4)in idiopathic membranous nephropathy(IMN)in adults.Methods The clinical data of 70 patients with membranous nephropathy admitted to Xinyu People′s Hospital from April 2017 to April 2019 were retrospectively collected,and divided into IMN group(30 cases)and secondary membranous nephropathy group(40 cases)according to the etiology.All patients received serum PLA2R and renal tissue IgG 4 detection,and the diagnostic value of serum PLA2R combined with renal tissue IgG 4 detection for IMN was analyzed.Results The level of serum PLA2R in IMN group was higher than that in SMN group,and the difference was statistically significant(P<0.05).The ROC curve was drawn with serum PLA2R level as the test variable and the incidence of IMN disease as the dependent variable(1=IMN,0=SMN).The diagnostic threshold of IMN was 25.641 RU/mL of serum PLA2R,when serum PLA2R>25.641 RU/mL was identified as IMN.At this time,the diagnostic AUC was 0.919(P<0.05).The diagnostic accuracy of serum PLA2R and renal tissue IgG 4 combined detection for IMN was 93.33%,which was higher than that of serum PLA2R and renal tissue IgG 4 alone detection(81.43%,85.71%),the differences were statistically significant(P<0.05).The serum levels of PLA2R and renal tissue IgG 4 alone in detecting IMN were in good consistency with renal biopsy(Kappa=0.622,0.706).Combined detection of IMN and renal biopsy showed great consistency(Kappa=0.912).Conclusion The detection of serum PLA2R combined with renal tissue IgG 4 has a high diagnostic value for IMN disease.Targeted preventive measures can be made in time according to the detection results of serum PLA2R combined with renal tissue IgG 4 in clinical practice.