特发性膜性肾病患者血清磷酸脂酶A2受体抗体水平的临床意义

Clinical significance of serum phospholipase A2 receptor antibody in patients with idiopathic membranous nephropathy

目的研究特发性膜性肾病患者血清磷酸脂酶A2受体(PLA2R)抗体水平的临床意义。方法选择该院2015年1月至2018年1月诊治的膜性肾病(MN)患者100例(MN组),根据经皮肾穿刺诊断为特发性膜性肾病(IMN)患者50例(IMN组),非IMN患者50例(非IMN组),另选同期体检健康者50例为健康对照者(健康对照组)。检测各组研究对象的血清PLA2R抗体,给予患者相应治疗。统计血清PLA2R抗体阳性率,统计不同抗体滴度的IMN患者清蛋白、肾小球滤过率估算值(eGFR)、肾病范畴蛋白尿比例,检测IMN患者抗体阳性与抗体阴性的临床指标水平,比较抗体阳性组与抗体阴性组的疗效。结果 IMN组PLA2R抗体阳性率为86.00%,非IMN组抗体阳性率为20.00%,健康组PLA2R抗体阳性率为0.00%;不同抗体滴度的IMN患者血清清蛋白、肾小球滤过率估算值(eGFR)水平、肾病范畴蛋白尿比例差异有统计学意义(P<0.05);抗体阳性组24h蛋白尿、大量蛋白尿高于抗体阴性组,血清清蛋白低于抗体阴性组,差异均有统计学意义(P<0.05);抗体阳性组血肌酐、尿素氮水平与抗体阴性组差异无统计学意义(P>0.05),抗阳性组与抗阴性组总缓解率差异无统计学意义(P>0.05)。结论 IMN患者PLA2R抗体阳性率明显高于其他MN患者及健康者,抗体滴度越高的患者清蛋白、eGFR水平越低,蛋白尿比例越高。

Objective To study the clinical significance of phospholipase A2 receptor(PLA2R)antibody in patients with idiopathic membranous nephropathy(IMN).Methods A total of 100 cases of patients with MN from January 2015 to January 2018 were selected According to percutaneous nephrolithotomy,there were 50 cases of IMN and 50 cases of non-IMN.And 50 cases patients with healthy physical examination were selected as healthy group.The PLA2R antibody was tested in all patients and patients were given appropriate treatment.The positive rate of serum PLA2R antibody in three groups was counted.The serum albumin,estimated glomerular filtration rate(eGFR)level and the proteinuria ratio of renal disease were counted in IMN patients with different antibody titers.The clinical indicators were detected in IMN patients with antibody-positive and antibody-negative,and the efficacy was counted in antibody-positive group and antibody-negative group.Results The positive rate of PLA2R antibody was 86.00%in IMN group,20.00%in non-IMN group and 0.00%in healthy group.There were significant differences in serum albumin and eGFR levels and proteinuria ratio of renal disease in IMN patients with different antibody titers(P<0.05).The 24 h proteinuria and a large amount of proteinuria in antibody-positive group were higher than those in antibody-negative group while the serum albumin was lower than that in antibody-negative group(P<0.05).There was no significant difference in the levels of serum creatinine and urea nitrogen between antibody-positive group and antibody-negative group,and there was no significant difference in the total remission rate between the antibody-positive group and antibody-negative group(P>0.05).Conclusion The positive rate of PLA2R antibody in IMN patients is significantly higher than that of other MN patients and healthy people.The higher the antibody titer is,the lower the levels of serum albumin and eGFR are,and the higher the proteinuria ratio is.