抗磷脂酶A2受体抗体在特发性膜性肾病检测的临床意义

目的探讨抗磷脂酶A2受体（PLA2R）抗体检测在特发性膜性肾病（IMN）中的，临床意义。方法选择2016年1月至12月期间行肾活检并确诊的IMN患者38例，继发性膜性肾病（SMN）患者46例，以同期体检中心志愿者30例作为对照，采用定量检测血清中抗PLA2R抗体并加以分析。结果与对照组比较发现，IMN组中抗PLA2R抗体水平显著升高，差异有统计学意义（P〈0．05）；SMN组中抗PLA2R抗体水平稍微升高，差异无统计意义（P〉0．05）。与SMN组比较，IMN组中抗PLA2R抗体水平显著升高，差异有统计学意义（t=4．937，P〈0．05）。抗PLA2R抗体的敏感度为68．4％，特异度为93．5％，阳性预测值为89．7％，阴性预测值为78．2％。在病理Ⅰ、Ⅱ、Ⅲ分期中检出率分别是38．5％（5／13），83．3％（15／18），85．7％（6／7）。结论PLA2R抗体在IMN中较高的敏感度和特异度，可作为实验室诊断指标之一，可用于IMN与SMN之间鉴别。

Objective To investigate the clinical significance of antibody of anti-phosphase A2 receptor （ PLA2R ） amibody in idiopathic membranous nephropathy （ IMN ） . Methods From January 2016 to December 2016, there were 38 cases of IMN diagnosed at the first people＇s hospital in Hangzhou, 46 cases were secondary membranous nephropathy （ SMN ） , they were compared to 30 volunteers at the same time.The anti- PLA2R antibody in serum was analyzed by the quantitative. Results Compared with the control group, the anti- PLA2R antibody level of IMN group was significantly higher, and the difference was statistically significant （ P〈0.05 ） .The anti-PLA2R antibody levels in the SMN group were slightly elevated, the difference was not statistically significant （ P〉0.05 ） . In the IMN group, the anti- PLA2R antibody levels were significantly higher in the IMN group than the SMN group, and the difference was statistically significant （ P〈0.05 ） . The sensitivity of the anti-PLA2R antibody was 68.4%, the specificity was 93.5%, the positive predictive value was 89.7%, the negative predictive value was 78.2%. In pathological I , II, Ill stage, the detection rates were 38.5% （ 5/13 ） , 83.3% （ 15/18 ） , 85.7% （ 6/7 ） , respectively. Conclusion The high sensitivity and specificity of the PLA2R antibody in IMN can be used as a laboratory diagnostic indicator, which can be used to identify between IMN and SMN.