M型磷脂酶A2受体抗体及免疫球蛋白IgG亚型在乙型肝炎病毒相关膜性肾病中的检测

The clinical value of plasma M type phospholipase A2 receptor antibody and IgG subtypes deposition in diagnosis of hepatitis B virus-associated membranous nephropathy

目的通过比较原发性膜性肾病(IMN)和乙型肝炎病毒相关膜性肾病(HBV-MN)患者血清中M型磷脂酶A2受体抗体(PLA2R)水平及肾活检组织中IgG亚型沉积情况,探讨PLA2R抗体和IgG亚型对HBV-MN诊断的意义。方法应用ELISA法检测了10例IMN患者和25例HBV-MN患者血清中浓度,以同期7例微小病变肾病(MCD)患者血清检测作为阴性对照。通过免疫荧光方法检查免疫球蛋白IgG亚型在IMN和HBV-MN患者肾活检组织中的沉积。结果在IMN组,患者血清M型PLA2R抗体浓度显著高于HBV-MN组患者,分别是(15.4±7.2)和(10.3±5.7)μg/mL,差异有统计学意义(P<0.05)。IgG亚型(IgG1、IgG2、IgG3和IgG4)在IMN组和HBV-MN组患者肾活检组织肾小球毛细血管壁的沉积无显著性区别。结论检测血清M型PLA2R抗体水平对区分HBV-MN和IMN患者具有一定价值,而IgG亚型在HBV-MN和IMN患者肾活检组织的分布则未发现明显不同。

Objective To investigate the different expressions of plasma M type phospholipase A2 receptor antibody and IgG subtypes deposition of kidney tissues in idiopathic membranous nephropathy and hepatitis B virus-associated membranous nephropathy,and to evaluate the significance of plasma M type phospholipase A2 receptor antibody and IgG subtypes in diagnosis of hepatitis B virus-associated membranous nephropathy.Methods Plasma samples were obtained from patients with idiopathic membranous nephropathy,hepatitis B virus-associated membranous nephropathy and minimal change disease,respectively,before immunosuppressive therapy.Concentration of plasma M type phospholipase A2 receptor antibody was detected by sandwich ELISA and concentration of IgG subtypes were measured by immunofluorescence.Results Concentration of plasma M type phospholipase A2 receptor antibody was （15.4±7.2）μg/mL in idiopathic membranous nephropathy group,higher than that in the hepatitis B virus-associated membranous nephropathy group （10.3±5.7）μg/mL （P〈0.01）,between idiopathic membranous nephropathy group and hepatitis B virus-associated membranous nephropathy group.There was no distinct difference of IgG subtypes deposition in glomerlar capillary wall.Conclusion There is obvious clinical significance of concentration of plasma M type phospholipase A2 receptor antibody in differential diagnosis of idiopathic membranous nephropathy and hepatitis B virus-associated membranous nephropathy,while no distinct significance of IgG subtypes deposition.