抗M型磷脂酶A2受体抗体在特发性膜性肾病治疗中的临床意义

Clinical significance of anti-M type phospholipase A2 receptor antibody in treatment of idiopathic membranous nephropathy

目的探讨抗M型磷脂酶A2受体(PLA2R)抗体在特发性膜性肾病(IMN)治疗中的临床意义。方法纳入2013年4月至2014年6月间在南通大学附属医院住院并行肾活检的61例初治肾脏病患者,采用间接免疫荧光法检测血清抗PLA2R抗体的表达,并收集相关临床资料进行分析。结果 61例患者中,19例IMN患者血清抗PLA2R抗体阳性率为89.5%(17/19),42例非IMN患者血清抗PLA2R抗体阳性率为7.14%(3/42)。17例抗PLA2R抗体呈阳性的IMN患者的抗体滴度为1 000±680,高于抗PLA2R抗体阳性非IMN患者的抗体滴度(P<0.05);就诊时IMN患者抗PLA2R抗体滴度与病程、尿蛋白量、血清白蛋白、血肌酐或内生肌酐清除率以及胆固醇水平无相关性(P>0.05)。共14例IMN患者随访观察6个月,治疗早期抗PLA2R抗体降低幅度较尿蛋白更明显,同一时间点完全缓解者抗PLA2R抗体滴度阴性,治疗无效者抗体滴度最高;与高滴度组相比,低滴度组达到部分缓解的时间短[(1.16±0.41)个月vs(2.85±1.86)个月,P<0.05];相同用药方案治疗1个月后发现抗PLA2R抗体滴度与疗效呈负相关。结论间接免疫荧光法检测血清抗PLA2R抗体在IMN中具有较高的阳性率。抗PLA2R抗体低滴度患者较早达到缓解,抗体持续高滴度提示可能需要更换治疗方案。抗PLA2R抗体对IMN的临床诊断、鉴别诊断以及判断IMN病情活动、制定治疗方案具有重要的临床意义和指导价值。

Objective To investigate the clinical significance of anti-M type phospholipase A2 receptor（ PLA2R） antibody in the treatment of idiopathic membranous nephropathy（ IMN）. Methods A total of 61 renal disease patients with renal biopsy from April2013 to June 2014 were enrolled. The anti-PLA2 R antibody in serum was detected by indirect immunofluorescence technique（ IIFT）.And the clinical,laboratory and pathological data were collected in this retrospective study. Results In the 19 IMN patients,the positive rate of anti-PLA2 R antibody was 89. 5%（ 17 /19）,while the positive rate of 42 non-IMN patients was 7. 14%（ 3 /42）. The average titer of anti PLA2 R antibody in 17 cases of first diagnosed IMN were 1 000 ± 680,which was significantly higher than those of nonIMN patients with positive PLA2 R antibody（ P 〈0. 05）. The PLA2 R antibody titer was independent during the IMN course and uncorrelated with the amount of urinary protein,serum albumin,serum creatinine,creatinine clearance rate and cholesterol levels. The PLA2 R antibody titer in the 14 patients who were first diagnosed IMN and followed up for 6 months reduced more obviously than the amount of urinary protein in the early stage of treatment. At the same time point,the PLA2 R antibody titers in the patients with complete remission were negative,and in the patients with ineffective remission the antibody titers were highest. Compared with patients with high PLA2 R antibody titer,the patients with low PLA2 R antibody titers underwent shorter remission time（ 1. 16 ± 0. 41 months vs.2. 85 ± 1. 86 months,P〈 0. 05）. The PLA2 R antibody titer was negatively correlated with the treatment efficacy in the patients after treatment with the same regimen for one month. Conclusion High positive rate of PLA2 R antibody detected by IIFT was found in IMN patients. The patients with low PLA2 R antibody titers may remit earlier. The sustained high titer of PLA2 R antibody indicates the therapeutic regimen should be changed. The detection of PLA2 R antibody presents important significance and clinical guiding value for clinical diagnosis,differential diagnosis,evaluation of disease activity and choice of treatment scheme.