血清中抗磷脂酶A2受体特异性抗体的两种检测方法比较

Comparison of two methods to detect M-phospholipase A2 receptor antibodies in serum

目的:比较两种不同方法检测特发性膜性肾病(Idiopathic membranous nephropathy,IMN)患者血清磷脂酶A2受体(M-Phospholipase A2 Receptor,PLA2R)抗体检出率,评价两种方法检测抗体对疾病的诊断价值。方法:病例为2014年12月至2015年10月中国医科大学附属盛京医院收治的IMN及其他明确病理诊断的入院患者,分为IMN组和非IMN组,整理临床资料;采用间接免疫荧光法(Indirect immunofluorescence assay,IFA)和酶联免疫吸附试验(Enzyme linked immunosorbent assay,ELISA)对患者血清抗PLA2R抗体进行检测。结果:IFA方法与ELISA方法检测抗PLA2R抗体的敏感度分别为71.3%、68.5%,特异度均为100%,两者ROCAUC分别为0.860、0.839,两种方法的诊断效能无统计学差异(P>0.05),且两种方法有较好的一致性(κ=0.876),一致率达93.8%;抗体阳性的患者,易出现血清血白蛋白水平的降低(P<0.05);抗体滴度越高患者的低蛋白血症越严重,发生大量蛋白尿比例越高(P<0.05)。结论:两种方法检测血清中PLA2R抗体均有较高的敏感度和特异度,该抗体可作为IMN患者良好的诊断指标。

Objective： To compare the difference of serum levels of M-phospholipaseA2 receptor （PLA2R） antibodies in patients with idiopathic membranous nephropathy （IMN） detected by two different methods and evaluate the diagnostic value of two methods. Methods： Patients diagnosed as membranous nephropathy and other diseases with biopsy-proven from december 2014 to october 2015 in Shengjing Hospital of China Medical University were enrolled and devided into IMN group and non-IMN group. The serum levels of anti-PLA2R antibody were detected by both indirect immunofluorescence assay（IFA） and enzyme linked immunosorbent assay（ELISA）. Results： The sensitivity of IFA and ELISA in IMN were 71.3% and 68.5%, and the specificities of two methods were the same as 100%. The area under ROC curves of anti-PLA2R antibody for IMN diagnosis were 0. 860 and 0. 839. The diagnostic value of IFA and ELISA was no statistically significant differences in IMN （ P〉0. 05 ）, and the consistency of two methods was better（ K = 0. 876 ）. The IMN patients of positive anti-PLA2R antibody be susceptible to the low level of serum albumin （ P〈0. 05 ） i The higher levels of PLA2R antibody were linked with tile wbrse hypoproteinemia and the higher rate of nephrotic-range proteinuria in IMN patients. Conclusion： Two methods of detecting sera PLA2R antibody have higher sensitivity and specificity, so the sera anti-PLA2R antibody was a better biomarker in the diagnosis of idiopathic membranous nephropathy.