成人特发性膜性肾病肾组织M型磷脂酶A2受体1抗原与临床的相关性

Clinical significance of M-type phospholipase A2 receptor 1 in renal tissue of patients with idiopathic membranous nephropathy

目的检测成人特发性膜性肾病(IMN)患者肾组织M型磷脂酶A2受体1(PLA2R1)抗原,并判断该抗原与膜性肾病的临床关系。方法选取2013年1月~2016年5月我院经肾活检证实的IMN 63例,排除继发性膜性肾病。使用新鲜冰冻组织,采用间接免疫荧光法检测IMN肾组织PLA2R1抗原。结果在63例IMN中,48例肾组织发现PLA2R1抗原沉积,阳性率为76.19%。PLA2R1沿肾小球毛细血管袢呈细颗粒状沉积。肾组织PLA2R1抗原阳性者与阴性者对比有较高的血肌酐、较高的24h尿蛋白,较低的血清白蛋白(P<0.05)。结论特发性膜性肾病肾组织PLA2R1抗原阳性率较高。对于该抗原阴性患者应积极寻找是否存在继发因素,以排除继发性膜性肾病。该抗原与临床严重性有关,在临床工作中应注意进行相关指标的检测及加强对该抗原阳性病例的随访。

Objective To detect the expression of M-type phospholipase A2receptor1(PLA2R1)in renal tissue of patients with idiopathic membranous nephropathy(IMN)and to determine the relationship between the antigen and membranous nephropathy.Methods63adult patients with IMN were involved in this study from Jan2013to May2016in our hospital.IMN was diagnosed by renal biopsy.And secondary membranous nephropathy was excluded through detailed inquiry of history,laboratory examination,renal biopsy.PLA2R1antigen in renal tissue was detected by indirect immunofluorescence.Results The PLA2R1antigen was found in48patients,positive rate was76.19%.PLA2R1was detected in a finely granular pattern in sub-epithelial deposits along glomerular capillary loops.Patients with PLA2R1antigen had higher blood creatinine,higher24hours urine protein,lower serum albumin(P<0.05).Conclusion The positive rate of PLA2R1antigen in renal tissue of idiopathic membranous nephropathy is higher.It is necessary to find out whether there are secondary factors to exclude secondary membranous nephropathy.The antigen is associated with clinical severity.In clinic,the attention should be paid to the detection of relevant indicators and strengthen the follow-up of the antigen positive cases.