PLA 2R抗体水平与原发性膜性肾病患者病情及治疗预后的相关性

The correlation between the level of PLA 2R and the condition and prognosis of patients with primary membranous nephropathy

目的探讨血清抗磷脂酶A2受体(PLA 2R)抗体水平与原发性膜性肾病(PMN)患者病情及治疗预后的相关性。方法回顾性分析2017年1月至2019年8月于江苏省中医院明确诊断为PMN的61例患者的病例资料,根据PLA 2R抗体水平将其分为PLA 2R阳性组(41例)与PLA 2R阴性组(20例)。收集两组患者性别、年龄等一般资料以及相关血清学实验指标,分析两组患者的临床病理特点及预后,采用Spearman相关性分析PLA 2R抗体水平与病情、治疗预后的相关性。结果PLA 2R阳性组估算肾小球滤过率(eGFR)、总蛋白(TP)、白蛋白(ALB)水平低于PLA 2R阴性组,血清24 h尿蛋白、IgG4水平高于PLA 2R阴性组(均P<0.05);多因素logistic回归分析结果显示24 h尿蛋白是PLA 2R抗体水平的独立危险因素(OR=2.242,P<0.05),而TP、ALB水平是其保护因素(OR=0.840、0.674,P<0.05);两组患者均以复查血清学指标等方式进行为期1年的随访。PLA 2R阳性组完全缓解率及总缓解率较PLA 2R阴性组低(P<0.05);Spearman相关性分析结果显示PLA 2R阳性组PLA 2R抗体水平与TP、ALB水平及患者治疗预后呈负相关(r=-0.642、-0.547,-0.357,P<0.05);与24 h尿蛋白水平呈正相关(r=0.347,P<0.05)。61例患者肾组织PLA 2R检测发现63.93%(39/61)的患者PLA 2R阳性。结论PLA 2R抗体水平与PMN患者体内血清白蛋白、TP、24 h尿蛋白以及患者预后密切相关。

Objective To investigate the correlation between serum anti phospholipase A2 receptor(PLA 2R)antibody level and the condition and prognosis of patients with primary membranous nephropathy(PMN).Methods 61 patients who were diagnosed as PMN in the laboratory department of Jiangsu Province Hospital of Chinese Medicine from January 2017 to August 2019 were selected and divided into PLA 2R positive group(41 cases)and PLA 2R negative group(20 cases)according to the level of PLA 2R antibody.The gender,age and other general data of the two groups were collected,and the clinical pathological characteristics and prognosis of the two groups were analyzed.Spearman correlation was used to analyze the correlation between the level of PLA 2R antibody and the disease condition and treatment prognosis.Results The levels of estimate glomerular filtration rate(eGFR),total protein(TP)and albumin(ALB)in PLA 2R positive group were lower than those in PLA 2R negative group,while the levels of 24-h urinary protein and IgG4 were higher in PLA 2R positive group than that in PLA 2R negative group(P<0.05);Multivariate logistic regression analysis showed that 24-hour urinary protein was an independent risk factor for PLA 2R antibody level(OR=2.242,P<0.05),while TP and ALB levels were protective factors(OR=0.840,0.674,P<0.05);The patients in both groups were followed up for one year by rechecking serological indexes.The complete remission rate and total remission rate of PLA 2R positive group were lower than those of PLA 2R negative group(P<0.05);Spearman correlation analysis showed that the level of PLA 2R antibody was negatively correlated with the levels of TP,ALB,and prognosis of patients(r=-0.642,-0.547,-0.357,P<0.05),and positively correlated with the level of 24-hour urinary protein(r=0.347,P<0.05).PLA 2R in renal tissue of 61 patients was found to be positive in 63.93%(39/61).Conclusions The level of PLA 2R antibody is closely related to serum albumin,TP,24 h urinary protein and prognosis of patients with PMN.