血清抗磷脂酶A2受体抗体水平对特发性膜性肾病诊断和病情评估的临床价值

The clinical value of serum anti-phospholipase A2 receptor antibodies(PLA2R) level in the diagnosis and condition evaluation of idiopathic membranous nephropathy

目的分析血清抗磷脂酶A2受体(PLA2R)抗体在特发性膜性肾病(IMN)患者中的表达,评价其在特发性膜性肾病诊断中的临床应用价值。方法对218例研究对象包括经肾活检确诊的120例IMN患者,98例非特发性膜性肾病(NIMN)患者(其中狼疮性肾炎45例,乙肝病毒相关性肾炎23例,淀粉样变性病3例,IgA肾病17例,紫癜性肾炎10例)及100例健康体检者,应用酶联免疫吸附试验(ELISA)检测血清中的抗PLA2R抗体水平,观察抗体含量高低并分析其对IMN的敏感度和特异度及其与IMN组病理分期进行相关性分析。组间比较采用t检验,χ~2检验做相关性分析。结果 (1)ELISA法检测抗PLA2R抗体敏感度和特异度分别为72.5%和100%。与NIMN和健康对照组差异有统计学意义(P<0.01)。(2)血清抗PLA2R抗体与肾穿刺活检病理诊断的相关性分析,其阳性符合率为72.5%,阴性符合率为100%,一致性检验Kappa=0.703,P<0.001。(3)IMN组抗PLA2R抗体含量高低与病理分期无相关性。结论抗PLA2R抗体在IMN中具有较高的敏感性和特异性,可能是诊断及评估IMN患者病情变化的新的血清学标志物。

Objective To analyze the expression of serum anti-phospholipase A2 receptor antibodies(PLA2R)in idiopathic membranous nephropathy,and to investigate its value in the clinical application.Methods Anti-PLA2R antibody was detected by enzyme-linked immunosorbent assay(ELISA)in 218 serum samples including 120 patients with diagnosed IMN by puncturing kidney,98 from NIMN and 100 healthy controls.The sensitivity and specificity of anti-PLA2R antibody in IMN were analyzed and the level of anti-PLA2R antibody with IMN pathology staging were compared.Results 1)The sensitivity and specificity of anti-PLA2R antibody in IMN were 72.5%and 100%,which were significantly higher in the IMN group than those in NIMN and the healthy controls.2)Correlation analysis between anti-PLA2R and pathological diagnosis showed a positive coincidence rate of 72.5%,negative coincidence rate of 100%and the Kappa value of consistency test of 0.703,P<0.001.3)There were no correlation between the level of anti-PLA2R antibody with IMN pathology staging.Conclusion Anti-PLA2R antibody may be an valuable parameter for the appraising and diagnosing IMN with high sensitivity and specificity.