血清PLA2R抗体、肾小球PLA2R及IgG4检测在膜性肾病诊断中的作用

The detections of serum PLA2R antibody,glomerular PLA2R and IgG4 in the diagnosis of membranous nephropathy

目的探讨血清抗M型磷脂酶A2受体(PLA2R)抗体、肾小球PLA2R及Ig G4检测在膜性肾病中的作用。方法选择2015年10月-2017年8月医院收治并经肾活检术确诊的83例膜性肾病患者,其中68例特发性膜性肾病(IMN)患者,15例继发性膜性肾病(SMN)患者,间接免疫荧光试验法测定血清抗PLA2R抗体,免疫荧光法测定肾小球PLA2R表达及Ig G4沉积,对比分析受试者指标表达阳性率。结果 IMN患者中88.24%(60/68)肾小球PLA2R表达阳性,72.06%(49/68)血清抗PLA2R抗体阳性,91.18%(62/68)Ig G4亚型沉积阳性;SMN患者中6.67%(1/15)肾小球PLA2R表达阳性,13.33%(2/15)血清抗PLA2R抗体阳性,26.67%(4/15)Ig G4亚型沉积阳性,2组阳性率比较差异有统计学意义(P<0.05);血清抗PLA2R抗体及肾小球PLA2R、Ig G4亚型沉积阳性诊断IMN灵敏度及特异度分别为72.06%、88.24%、91.18%及86.67%、93.33%、73.33%。86.76%(59/60)IMN患者肾小球PLA2R表达阳性伴Ig G4中度以上阳性,SMN患者中无一例肾小球PLA2R表达阳性伴Ig G4中度以上阳性。结论 IMN患者肾小球PLA2R表达阳性率高,血清抗PLA2R抗体及肾小球PLA2R、Ig G4亚型沉积阳性可作为膜性肾病鉴别诊断中的参考指标。

Objective To investigate the role of serum anti-M-type phospholipase A2 receptor（ PLA2 R） antibody,glomerular PLA2 R and Ig G4 detection in the diagnosis of membranous nephropathy. Methods A total of 83 patients with membranous nephropathy admitted to our hospital from October 2015 to August 2017 and confirmed by renal biopsy were selected,including68 patients with idiopathic membranous nephropathy（ IMN） and 15 patients with secondary membranous nephropathy（ SMN）.Serum anti-PLA2 R antibody was detected by indirect immunofluorescence assay. PLA2 R expression and Ig G4 deposition in glomeruli were detected by immunofluorescence. The positive rate of the expression was compared. Results In IMN patients,the positive rate of PLA2 R expression was 88. 24%（ 60/68）,anti-PLA2 R antibody in serum was 72. 06%（ 49/68）,Ig G4 subtype was 91. 18%（ 62/68）. In SMF patients,the positive rate of PLA2 R expression was 6. 67%（ 1/15）,anti-PLA2 R antibody in serum was 13. 33%（ 2/15）,and Ig G4 subtype was 26. 67%（ 4/15）,with the differences statistically significant between the two groups（ P 〈0. 05）. The sensitivity and specificity of serum anti-PLA2 R antibody,glomerular PLA2 R and Ig G4 subtype were 72. 06%,88. 24%,91. 18%,86. 67%,93. 33%,73. 33%,86. 76%（ 59/60） in IMN patients with glomerular PLA2 R expression positive and Ig G4 moderate positive,and no cases of SMN patients with glomerular PLA2 R expression positive and Ig G4 moderate positive was found. Conclusion The positive rate of glomerular PLA2 R expression is high in IMN patients,serum anti-PLA2 R antibody,glomerular PLA2 R and Ig G4 subtype deposition positive can be used as differential index in the diagnosis of membranous nephropathy.