抗磷脂抗体各亚型在102例原发性肾小球疾病中的表达研究

Study on the expression of antiphospholipid antibody subtypes in primary glomerulopathy

目的探讨原发性肾小球疾病中抗磷脂抗体(APA)及各亚型表达情况。方法选取2015年6月至2017年7月,在浙江大学医学院附属第一医院肾脏病中心行肾穿刺活检,并确诊为原发性肾小球疾病的患者1021例(包括膜性肾病303例,IgA肾病483例,系膜增生性肾小球肾炎76例,微小病变肾病119例,局灶性节段性肾小球硬化40例),检测抗心磷脂抗体(ACL)不同亚型(IgG、IgM和IgA型)和抗β2糖蛋白1(β2GP1)抗体不同亚型(IgG、IgM和IgA型),并进行比较。结果膜性肾病组APA阳性率最高为17.5%,微小病变型肾病组最低为11.8%,组间比较差异无统计学意义。IgA肾病和系膜增生性肾小球肾炎ACL阳性率分别为11.4%和14.5%,均显著高于抗β2GP1抗体阳性率(P<0.001,P=0.009);膜性肾病组抗β2GP1抗体阳性率为11.2%,与ACL阳性比差异无统计学意义,但显著高于其余4组患者。系膜增生性肾小球肾炎组ACL-IgM阳性率为13.2%,明显高于其余4组(P<0.05)。IgA肾病组ACL-IgA阳性率为5.8%,明显高于其余4组,差异有统计学意义(P<0.05)。结论原发性肾小球疾病患者中存在抗磷脂抗体阳性,其亚型在不同病理类型肾炎患者中阳性率差异有统计学意义,可有助于疾病鉴别诊断以及治疗。

Objective To discuss expression of antiphospholipid antibody subtypes in primary glomerular diseases.Methods All1021 cases who were admitted to our center between June 2015 and July 2017 in Kidney Disease Center,First Affiliated Hospital,College of Medicine,Zhejiang Universityhad renal biopsy in our center and they were praved to have primary glomerular diseases(303 cases of membranous nephropathy,483 cases of IgA nephropathy,76 cases of mesangial proliferative glomerulonephritis,119 cases of minimal change nephropathy and 40 cases of focal segmental glomerulosclerosis).The levels of anti-cardiolipin(ACL)antibody subtypes(IgG,IgM and IgA)and anti-β2 glycoprotein 1(β2 GP1)antibody subtypes(IgG,IgM and IgA)were measured and compared.Results The positive rate of APA in membranous nephropathy group was highest(17.5%)and in minimal change nephropathy was lowest group(11.8%),but there were no significant differences among the groups.The positive rates of ACL in IgA nephropathy and mesangial proliferative glomerulonephritis were 11.4% and 14.5% respectively,which were significantly higher than those of anti-β2 GP1 antibody(P< 0.001,P = 0.009 respectively).The positive rate of anti-β2 GP1 antibody in membranous nephropathy group was 11.2%,significantly higher than that in the other four groups.The positive rate of ACL-IgM in mesangial proliferative glomerulonephritis group was 13.2%,which was significantly higher than that in the other four groups(P< 0.05).The positive rate of ACL-IgA in IgA nephropathy group was 5.8%,which was significantly higher than the other four groups,and there was no statistical difference(P<0.05).Conclusion Antiphospholipid antibody is positive in patients with primary glomerular diseases,and the positive rate of its subtypes varies among the different pathological types of glomerulonephritis,which can be helpful to differential diagnosis and treatment of the disease.