血清磷脂酶A2受体抗体在特发性膜性肾病缓解中的价值

The significance of serum phospholipase A2 receptor antibody in remission of idiopathic membranous nephropathy

目的通过队列研究分析血清磷脂酶A2受体抗体（phospholipaseA2receptorantibody，PLA2R-Ab）在特发性膜性肾病（idiopathicmembranousnephropathy，IMN）缓解中的价值。方法纳人2014年12月113至2017年8月31日在华中科技大学同济医学院附属同济医院住院，通过病史、体格检查、实验室检查、肾穿刺活检术等确诊为IMN的患者108例进行回顾性队列研究，收集患者的相关资料。依据血清PLA2R-Ab情况将患者分为阳性组和阴性组，并进行组间资料比较；用Kaplan．Meier法计算缓解率，以Log-rank（Mantel-Cox）检验比较组间缓解率；采用单因素和多因素Cox回归分析评估影响缓解的因素。结果108例患者中，血清PLA2R．Ab阳性73例（67．6％）。相对于血清PLA2R-Ab阴性组，阳性组男性患者所占比例高（P=0．002）、血清白蛋白水平低（P〈0．001）、总胆固醇水平高（P〈0．001）、IgG水平低（P〈0．001）、24h尿蛋白量高（P=O．003）、总缓解率低（P=0．049）、达到部分缓解所用时间长（P=0．001）、达到完全缓解所用时间长（P=O．002）。全部患者的1年、2年的累积部分缓解率分别为72．4％、86．1％，累积完全缓解率分别为43．8％、54．O％。血清PLA2R-Ab阴性组的累积部分缓解率、累积完全缓解率均高于血清PLA2R-Ab阳性组（x2=9．84，P=0．002；x2=15．50，P〈0．001）。多因素Cox回归分析结果显示，血清PLA2R-Ab阳性是缓解的独立危险因素。结论IMN患者中，血清PLA2R．Ab阳性者较阴性者病情重，缓解率低。血清PLA2R-Ab阳性是IMN患者缓解的独立危险因素。

Objective To identify the significance of serum phospholipase A2 receptor antibody （PLA2R- Ab） in idiopathic membranous nephropathy （IMN） patients. Methods A total of 108 patients diagnosed as IMN by medical history, physical examination, laboratory examination and renal biopsy in Tongji Hospital affiliated to Tongji Medical College, Huazbong University of Science and Technology between Dec 1, 2014 and Aug 31, 2017 were enrolled, and all related data were recorded. According to the results of serum PLA2R-Ab test, patients were divided to positive group and negative group, and the data were compared with the independent sample t test and the ehi-square test, Kaplan-Meier survival analysis was performed to compare remission rates between groups, and the Logrank method was used to evaluate the significance of differences. Univariate and multivariate Coxregression analysis were used to verify predicting factors for achieving remission. Results Overall, 67.6%（73/108） patients had detectable serum PLA2R-Ab. Compared with patients in negative group, patients in positive group exhibited higher proportion of male patients （P=0.002）, lower level of serum albumin （P 〈 0.001）, higher level of cholesterol （P 〈 0.001）, lower level of immunoglobulin G （P 〈 0.001）, higher level of proteinuria （P=0.003）, a lower of chance of remission （P=0.049）, longer time needed to achieve partial remission （P=0.001） and complete remission （P=0.002）. The 1- and 2-year cumulative renal partial remission rates were 72.4%, 86.1%, and the cumulative renal complete remission rates were 43.8%, 54.0%, respectively. Patients in negative group had higher partial remission 0（2=9.84, P=0.002） and complete remission 0（2=15.50, P〈0.001） than those in positive group. Multivariate Cox regression model indicated that serum positive PLA2R- Ab was a significant independent risk factor. Conclusions IMN patients with serum PLA2R- Ab show more severe condition and lower remission rates than those without serum PLA2R-Ab. Serum positive PLA2R-Ab is an independent remission-related predictor for IMN patients.