不同方案治疗血清抗M型磷脂酶A2受体抗体阴性与阳性特发性膜性肾病疗效比较

Comparison of the efficacy of different regimens in the treatment of serum anti-M phospholipase A2 receptor antibody negative and positive idiopathic membranous nephropathy

目的观察血清抗M型磷脂酶A2受体抗体(Anti-PLA2R Ab)阳性与阴性特发性膜性肾病患者特点及接受不同方案治疗后疗效差异,探寻血清Anti-PLA2R Ab阳性患者的相对最佳治疗方法。方法将150例经临床和肾脏病理确诊为特发性膜性肾病患者随机分为对照组、观察1组和观察2组,每组50例,每组患者再按其入组时基线血清Anti-PLA2R Ab检测水平分为阳性和阴性两亚组。在常规对症支持治疗基础上,对照组患者采用改良Ponticelli方案治疗,观察1组患者在对照组治疗基础上应用中药双肾俞穴敷熨疗法,观察2组患者在对照组治疗基础上应用中药俞募配穴敷熨疗法。比较3组中Anti-PLA2R Ab阴性与阳性患者治疗前及治疗1,2,3,6个月后24 h尿蛋白定量(24hUPro)、血清白蛋白(ALB)、血肌酐(SCr)水平的差异,统计3组中Anti-PLA2R Ab阴性与阳性患者治疗效果及不良反应发生情况。结果150例特发性膜性肾病患者Anti-PLA2R Ab阳性者占74.67%。3组特发性膜性肾病患者Anti-PLA2R Ab阳性者治疗前后24hUPro均显著高于Anti-PLA2R Ab阴性者(P均<0.05),ALB均显著低于Anti-PLA2R Ab阴性者(P均<0.05),而SCr比较差异无统计学意义(P均>0.05)。3组中Anti-PLA2R Ab阴性者治疗总有效率均为100%,均显著高于Anti-PLA2R Ab阳性者(P均<0.05);观察2组中Anti-PLA2R Ab阳性患者治疗总有效率均显著高于观察1组和对照组(P均<0.05),观察1组显著高于对照组(P<0.05)。不良反应均出现在Anti-PLA2R Ab阳性患者中,但观察2组感染、类固醇性糖尿病的发生率明显低于其他组(P均<0.05)。结论特发性膜性肾病患者Anti-PLA2R Ab阳性率高,且较Anti-PLA2R Ab阴性者临床指标重、治疗反应差、易出现不良反应;中药俞募配穴敷熨联合改良Ponticelli方案可有效提高Anti-PLA2R Ab阳性特发性膜性肾病患者疗效,值得推广应用。

Objective It is to observe the characteristics of serum anti-M-phospholipase A2 receptor antibody(Anti-PLA2R Ab)positive and negative idiopathic membranous nephropathy patients and the difference in efficacy after receiving different regimens,and to explore the better treatment regimen for serum anti-PLA2R Ab positive patients.Methods A total of 150 patients with idiopathic membranous nephropathy who were diagnosed by clinic and renal pathology were randomly divided into control group,observation group I and observation group II,50 cases in each group.The patients in each group were divided into positive and negative two subgroups according to their detection levels of baseline serum anti-PLA2R Ab.On the basis of routine symptomatic supportive treatment,the patients in the control group were treated with modified Ponticelli regimen,the patients in the observation group I were treated with acupoint application with traditional Chinese medicine on both Shenshu points on the basis of the control group,the patients in the observation group II were treated with acupoint application with traditional Chinese medicine on Shu-Mu points on the basis of the control group.The differences in 24hUPro,levels of serum albumin(ALB)and serum creatinine(SCr)between the anti-PLA2R Ab negative and positive patients in the 3 groups before and after 1,2,3,and 6 months of treatment were compared.The therapeutic effects and adverse reactions of anti-PLA2R Ab negative and positive patients in the three groups were statistically analyzed.Results The anti-PLA2R Ab positive patients in 150 patients with idiopathic membranous nephropathy accounted for 74.67%.The 24hUPro of anti-PLA2R Ab-positive patients in the three groups of patients with idiopathic membranous nephropathy were significantly higher than those of Anti-PLA2R Ab-negative patients before and after treatment(P<0.05),and ALB was significantly lower than those in Anti-PLA2R Ab-negative patients(P<0.05),and the difference in SCr was not statistically significant(P>0.05).The total effective rate of anti-PLA2R Ab-negative patients in the three groups was 100%,which was significantly higher than that of Anti-PLA2R Ab-positive patients(P<0.05).The total effective rate of anti-PLA2R Ab-positive patients in the observation group II was significantly higher than that of the observation group the observation group I and the control group(P<0.05),the observation group I was significantly higher than the control group(P<0.05).Adverse reactions were found in anti-PLA2R Ab-positive patients,and the incidence of infection and steroid diabetes in observation group II was lower than the other two groups(P<0.05).Conclusion The positive rate of Anti-PLA2R Ab in patients with idiopathic membranous nephropathy is higher,and their clinical indexes were more serious,the treatment response were poorer with more adverse reactions than the anti-PLA2R Ab negative patients.The acupoint application with traditional Chinese medicine on Shu-Mu points can effectively improve the efficacy of patients with Anti-PLA2R Ab-positive idiopathic membranous nephropathy,it is worthy of popularization and application.