三种实验室指标在膜性肾病中的诊断价值

Diagnostic Value of Three Kinds of Laboratory Indexes in Membranous Nephropathy

目的评估血清抗磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体与肾小球PLA2R和肾小球Ig G4沉积联合检测在特发性膜性肾病(IMN)中的诊断价值。方法应用间接免疫荧光法检测230例肾小球疾病患者血清抗PLA2R抗体。其中127例肾小球疾病患者同时应用免疫组化法检测肾小球PLA2R和Ig G4亚型沉积情况,受试者工作曲线(ROC)分析三种检测指标在IMN中的诊断价值,比较三种检测指标的一致性。结果血清抗PLA2R抗体与肾小球PLA2R或肾小球Ig G4表达一致性一般(Kappa值分别为0.748和0.703,P<0.01)。结论血清抗PLA2R抗体在IMN诊断中的有很高的敏感性和特异性。血清抗PLA2R抗体与肾小球PLA2R或肾小球Ig G4联合检测可提高检测灵敏度。

Objective To evaluate the diagnostic value of serum anti-phospholipase A2 receptor（PLA2R） antibodies and glomerular PLA2R and glomerular IgG4 deposits in the patients with idiopathic membranous nephropathy （IMN）. Methods Serum anti-PLA2R antibodies were detected by indirect immunofluorescence method in 230 patients with glomerular diseases. Meanwhile glomerular PLA2R and glomerular IgG4 deposits were analyzed in 127 cases of them. Receiver operating characteristic （ROC） curves were drawn to analyze the diagnostic value of the three indices in the IMN and to compare the consistency among them. Results There were some differences of the consistency of Serum anti-PLA2R antibodies and glomerular PLA2R or glomerular IgG4 deposits （Kappa values were 0.748, 0.703, P 〈 0.01）. Conclusion Serum anti-PLA2R antibodies is of high sensitivity and specifcity in IMN. And serum anti-PLA2R antibodies combined with glomerular PLA2R or glomerular IgG4 could improve the sensitivity of IMN.