血清抗磷脂酶A2受体抗体的表达与不典型膜性肾病患者临床病理特点及预后的关系

Relationship Between the Expression of Serum Anti-phospholipase A2 Receptor Antibody and Clinicopathological Characteristics and Prognosis in Adult Atypical Membranous Nephropathy Patients

目的探讨血清抗PLA2R抗体的表达与不典型膜性肾病(AMN)患者临床病理特点及预后的关系。方法选取2016年1月至2018年12月于郑州大学第一附属医院肾内科住院明确诊断为AMN的84例成人患者,根据血清抗PLA2R抗体结果,将患者分为血清抗PLA2R抗体阳性组(抗体阳性组,39例)和血清抗PLA2R抗体阴性组(抗体阴性组,45例)。收集患者的首次住院基线资料及随访资料,分析两组患者的临床病理特点及预后。结果抗体阳性组血白蛋白浓度比抗体阴性组低,24小时尿蛋白定量、总胆固醇、D-二聚体比抗PLA2R抗体阴性组高(均P<0.05)。两组尿素氮、肌酐、尿酸、甘油三酯、血沉、C反应蛋白比较,差异无统计学意义(P>0.05)。抗体阳性组IgG4阳性率高于抗体阴性组,差异有统计学意义(P<0.05)。两组间IgG1~IgG3比较,差异无统计学意义(P>0.05)。抗体阳性组治疗方案选择激素联合他克莫司有23例,抗体阴性组有28例。采用激素联合他克莫司方案治疗12个月后,抗体阳性组完全缓解率及总缓解率较抗体阴性组高,差异有统计学意义(均P<0.05)。激素联合他克莫司在AMN治疗中出现最多的不良反应为尿酸升高、感染。两组总不良反应发生率比较,差异无统计学意义(P>0.05)。结论抗PLA2R抗体阳性AMN患者比抗PLA2R抗体阴性患者发病时病情更重。抗PLA2R抗体阳性的AMN患者肾小球IgG亚型以IgG4沉积为主。激素联合他克莫司对于抗PLA2R抗体阳性的AMN患者长期治疗效果更好。

Objective To explore the relationship between the expression of serum anti-phospholipase A2 receptor(PLA2R) antibody and clinicopathological characteristics and prognosis in adult atypical membranous nephropathy(AMN) patients.Methods From January 2016 to December 2018, 84 cases which were composed of 39 cases of anti-PLA2R antibody positive AMN(antibody positive group) and 45 cases of anti-PLA2R antibody negative AMN(antibody negative group) diagnosed by kidney puncture biopsy in the First Hospital of Zhengzhou University were included into the study. Baseline data and follow-up data were collected, and the clinicopathological characteristics and prognosis of the two groups were analyzed and compared.Results Compared with antibody negative group, serum albumin was lower than antibody positive group, and the 24 h urinary protein quantification, total cholesterol, D-dimer were higher than those in antibody positive group(all P<0.05). There were no significant differences in blood urea nitrogen, creatinine, urea acid, erythrocyte sedimentation rate, C-reactive protein between two groups(all P>0.05). The positive rate of IgG4 deposits on glomeruli in antibody positive group were higher than antibody negative group(P<0.05). There were no significant differences in IgG1-IgG3 deposits on glomeruli between two groups(all P>0.05). There were 23 patients who chose tacrolimus combined with glucocorticoid for treatment in antibody positive group and 28 patients in antibody negative group. After 12 months of treatment, the complete remission rate and total remission rate of antibody positive group were higher than that of antibody negative group(both P<0.05). The most common adverse reactions were elevated uric acid and infection. There was no significant difference in total adverse reaction rate between the two groups(P>0.05).Conclusion AMN patients with anti-PLA2R antibody positive are likely to become sicker than those with anti-PLA2R antibody negative. The dominant IgG subclass deposits on glomeruli in anti-PLA2R antibody positive group is IgG4. Tacrolimus combined with glucocorticoid is more efficient in anti-PLA2R antibody positive patients in long-term treatment.