特发性膜性肾病患者血清抗PLA2R抗体表达研究

Expression of Serum Anti PLA2R Antibodies in Idiopathic Membranous Nephropathy

目的分析特发性膜性肾病患者血清抗 PLA2R抗体的表达，探讨其在特发性膜性肾病诊断及病情评估中的价值。方法收集经肾活检确诊的118例肾小球疾病患者，其中包括97例 IMN和21例 IgA肾病与19例健康体检者作为研究对象，应用 ELISA法检测血清抗 M型磷脂酶 A2受体（PLA2R）抗体表达水平，并分析其与 IMN患者血清清蛋白，24 h尿蛋白量等指标的相关性。结果 IMN组，IgA肾病组及健康体检组血清抗 PLA2R抗体含量中位数分别为45.2（3.6～705.9）RU／ml，5.9（2.3～10.6）RU／ml和1.2（0.6～9.3）RU／ml，IMN组血清抗PLA2R抗体含量高于 IgA肾病组及健康体检组，差异有统计学意义（t＝－5.027，－3.077；P均＜0.05）；97例 IMN患者中76例血清抗PLA2R抗体阳性，阳性率为78.35％，IgA肾病组与健康体检组均未检出阳性样本。IMN组患者血清抗PLA2R抗体与血清清蛋白呈负相关（r＝－0.453，P＜0.05）；与肌酐、胆固醇、红细胞沉降率、24 h尿蛋白呈正相关（r＝0.233，0.234，0.363，0.586；P 均＜0.05）。结论血清抗PLA2R抗体可作为 IMN特异性标志物用于 IMN的血清学诊断，并对评估 IMN患者病情的严重程度有重要参考意义。

Objective To analyze the expression of serum anti M phospholipase A2 receptor （PLA2R）antibody in idiopathic membranous nephropathy （IMN）,and to investigate its value in the diagnosis and evaluation of idiopathic membranous ne-phropathy.Methods One hundred and eighteen patients with biopsy-proved glomerular diseases were involved in this study, including 97 cases with IMN,21 cases with IgA nephropathy （IgAN）and 19 healthy people.ELISA was used to detect ser-um anti-PLA2R antibodies.Correlations of anti-PLA2R antibody level with laboratory parameters,including serum albumin, 24-hour urine protein of IMN patients were evaluated.Results The median of anti PLA2R antibody in IMN group,IgAN group and healthy group was 45.2（3.6~705.9）RU/ml,5.9（2.3~10.6）RU/ml and 1.2（0.6~9.3）RU/ml.The levels of serum anti PLA2R antibody in IMN group were higher than those in IgA nephropathy group and healthy control group.The difference was statistically significant （t=-5.027,-3.077;P=0.05）.Among 97 cases with IMN,76 cases showed posi-tive anti-PLA2R antibodies （positive rate 78.35%）.There was none patient showed positive anti-PLA2R antibody respec-tively in IgAN and healthy people.Furthermore,anti-PLA2R antibody level was negatively correlated with serum albumin （r=-0.453,P=0.000）and positively correlated with CREA,TC,ESR,24 hour urine protein （r=0.233,0.234,0.363, 0.586;P=0.004,0.217,0.021,0.000）in IMN patients.Conclusion Serum anti PLA2R antibody may be used as a IMN specific marker for the diagnosis of IMN,and it has important reference value for evaluating the severity of IMN.