M型磷脂酶A2受体抗体阳性与阴性的原发性膜性肾病患者的临床与病理特点比较

The differences in clinical and pathological features between patients positive and negative for M-type phospholipase A2 receptor antibody in idiopathic membranous nephropathy

目的比较M型磷脂酶A2受体抗体阳性与阴性的原发性膜性肾病患者的临床与病理特点。方法选取2015年5月至2017年10月北京大学第三医院肾内科147例原发性膜性肾病患者,根据血清抗PLA2R抗体检测结果分为PLA2R抗体阳性组和抗体阴性组。回顾分析临床及病理资料。结果抗体阳性组尿蛋白检测为(7.55±6.10)g/24h,抗体阴性组为(5.10±4.10)g/24h,抗体阳性组血清清蛋白为(27.71±5.93)g/L,抗体阴性组为(33.07±7.03)g/L,两组比较差异有统计学意义(P<0.05)。抗体阳性组估算的肾小球滤过率为(107.35±33.47)mL·min-1·1.73 m-2,抗体阴性组为(107.21±36.64)mL·min-1·1.73m-2,两组差异无统计学意义(P>0.05);在临床诊断方面,抗体阳性组肾病综合征的比例为80.00%,抗体阴性组肾病综合征比例为54.39%,两组差异有统计学意义(P<0.05);在肾脏病理方面,肾脏组织中IgG、IgM、IgA、IgG 1~4及C1q的沉积在抗体阳性组和抗体阴性组间差异无统计学意义(P>0.05),但两组C3沉积的差异有统计学意义(P<0.05);在治疗上,抗体阳性组中使用免疫抑制治疗的比例为82.22%,抗体阴性组的比例为57.89%,两组差异有统计学意义(P<0.05);在转归方面,抗体阳性组缓解率(包括完全缓解和部分缓解)为60.00%,抗体阴性组的缓解率为63.20%,差异无统计学意义(P>0.05)。结论在原发性膜性肾病中,相较于M型磷脂酶A2受体抗体阴性者,抗体阳性者临床上肾病综合征的表现更突出,肾组织中C3沉积较多,需要使用免疫抑制治疗的可能性更大。

Objective To compare the clinical and pathological features of patients who were positive and negative for M-type phospholipase A2 receptor（PLA2 R）antibody in idiopathic membranous nephropathy.Methods The clinical and pathological data of 147 cases of membranous nephropathy who were performed with renal biopsy in Peking University Third Hospital from May 2015 to October 2017 were retrospectively analyzed.Results There were no statistical significance in age and sex between the antibody-positive group and the antibody-negative group.The proteinuria levels were（7.55±6.10）g/24 hand（5.10±4.10）g/24 h respectively in PLA2 R positive and negative group.Serum albumin levels were（27.71±5.93）g/L and（33.07±7.03）g/L respectively.There was a statistically significant difference between the two groups（P〈0.05）.The estimated GFR were（107.35±33.47）mL·min-1·1.73 m-2 and（107.21±36.64）mL·min-1·1.73 m-2 respectively.There was no significant difference between the two groups.In terms of clinical diagnosis,the ratio of nephrotic syndrome in PLA2 Rantibody positive group and negative group was 80.00% and54.39%respectively.The difference between the two groups was statistically significant（P〈0.05）.In the kidney pathology,IgG,IgM,IgA,IgG 1-4 and C1 q deposition in kidney tissue were similar in both groups.But the difference of C3 deposition between the two groups were statistically significant（P〈0.05）.The usage rate of immunosuppressive therapy in the PLA2 Rantibody positive group and antibody-negative group were82.22% and 57.89%respectively.There was a statistical difference between the two groups（P〈0.05）.The remission rates（including complete remission and partial remission）were similar in both groups,which was60.00% and 63.20%respectively.Conclusion Compared with PLA2 Rantibody-negative patients,the PLA2 R antibody-positive idiopathic membranous nephropathy patients usually have more severe clinical manifestations.There is a high incidence of C3 deposition in the kidney tissue.And the need to use immunosuppressive therapy is more greater.