血清PLA2RAb阳性与阴性原发性膜性肾病患者实验室相关指标比较

Comparison of laboratory parameters in primary membranous nephropathy patients with positive and negative serum PLA2RAb

目的比较血清M型磷脂酶A2受体抗体(PLA2RAb)阳性与PLA2RAb阴性原发性膜性肾病(PMN)患者的实验室相关指标的差异。方法选取PMN患者97例,根据血清PLA2RAb表达情况分为PLA2RAb阳性组72例、PLA2RAb阴性组25例。采集两组患者空腹静脉血2 m L,检测血清肾功能指标,包括尿素氮(BUN)、肌酐(Cr);血脂指标,包括胆固醇(CHO)、甘油三酯(TG)、低密度脂蛋白(LDL)、脂蛋白a[Lp(a)];总蛋白(TP)、白蛋白(ALB)、Ig G4。留取24 h尿标本,采用邻苯三酚红钼法检测24 h尿蛋白。比较两组肾功能、血脂、蛋白、Ig G4及24 h尿蛋白指标。分析PLA2RAb阳性组血清PLA2RAb水平与各检验指标的相关性,分析两组Ig G4与24 h尿蛋白水平的相关性。多元线性回归模型分析PLA2RAb、Ig G4与24 h尿蛋白的关系,PLA2RAb联合Ig G4对PLA2RAb阳性PMN患者病情评估的价值。结果PLA2RAb阳性组LDL、Lp(a)、Ig G4及24 h尿蛋白均高于PLA2RAb阴性组(P <0. 05或0. 01)。PLA2RAb阳性组血清PLA2RAb水平与TP(r=-0. 398,P <0. 01)、ALB(r=-0. 426,P <0. 01)均呈负相关,与血清CHO(r=0. 393,P <0. 01)、Ig G4(r=0. 449,P <0. 01)及24 h尿蛋白(r=0. 588,P <0. 01)呈正相关。PLA2RAb阳性组Ig G4与24 h尿蛋白水平呈正相关(r=0.449,P <0.01); PLA2RAb阴性组Ig G4与24 h尿蛋白水平无相关性(r=0. 263,P=0. 203)。PLA2RAb(P <0. 01)及Ig G4(P <0.05)均与PLA2RAb阳性组24 h尿蛋白有线性回归关系。结论 PLA2RAb阳性的PMN患者脂类代谢异常及肾脏受损程度较PLA2RAb阴性者重,血清Ig G4较PLA2RAb阴性者高; PLA2RAb阳性患者血清Ig G4与24 h尿蛋白呈正相关,但PLA2RAb阴性患者血清Ig G4则与24 h尿蛋白无关。

Objective To explore the differences of laboratory parameters in primary membranous nephropathy(PMN)patients with positive and negative serum phospholipase A2receptor antibody(PLA2RAb).Methods A total of97patients with PMN were enrolled and were divided into PLA2RAb positive group(n=72)and PLA2RAb negative group(n=25)based on the titers of serum PLA2RAb.two mL of fasting venous blood was collected from all subjects.Renal function indicators including blood urea nitrogen(BUN)and serum creatinine(Cr),blood lipidindicators including cholesterol(CHO),triglyceride(TG),low density lipoprotein(LDL),high density lipoprotein(HDL)and lipoprotein a[Lp(a)],total protein(TP),albumin(ALB),and Immunoglobulin G4(IgG4)were measured at the time of diagnosis.The24-hour urine specimen were collected and24-hour urine protein was determined by phenol red molybdenum colorimetric method.Tests results of renal function indicators,blood lipid indicators,protein,IgG4,and24-hour urine protein were compared between the two groups.Correlation analysis were performed between PLA2RAb titers and biochemical indicators for patients in the PLA2RAb positive group,and the correlation of IgG4and24-hour urine protein were analyzed between the PLA2RAb positive and negative groups.Multiple linear regression was used to analyze the correlations of PLA2RAb and IgG4with24-hour urine protein,and the value of PLA2RAb combined with IgG4in evaluating the severity of PMN.Results Serum LDL,Lp(a),IgG4,PLA2RAb,and24-hour urine protein in the PLA2RAb positive group were higher than those of the PLA2RAb negative group(P<0.05or P<0.01).In the PLA2RAb positive group,the serum PLA2RAb was negatively correlated with T P(r=-0.398,P<0.01)and ALB(r=-0.426,P<0.01),but was positively correlated with CHO(r=0.393,P<0.01),IgG4(r=0.449,P<0.01)and24-hour urine protein(r=0.588,P<0.01).Serum IgG4was positively correlated with24-hour urine protein in the PLA2RAb positive group(r=0.449,P<0.01)and no correlation was found in PLA2RAb negative group(r=0.263,P=0.203).In the PLA2RAb positive group,both PLA2RAb(P<0.01)and IgG4(P<0.05)had a linear regression relationship with24-hour urine protein.Conclusions The abnormal of lipid metabolism and degree of renal damage are significantly heavier,and serum IgG4is higher in the PLA2RAb positive PMN patients than in PLA2RAb negative PMN patients.A positive correlation is found between serum IgG4and24-hour urine protein in PMN patients with positive PLA2RAb,nevertheless,no similar correlation was found in PLA2RAb negative patients.