IMN患者血清抗M型磷脂酶A2受体抗体水平及与治疗效果的相关性分析

Analysis on correlation between serum anti-M-type phospholipase A2 receptor antibody level and therapeutic effect in patients with idiopathic membranous nephropathy

目的探讨特发性膜性肾病(IMN)患者血清抗M型磷脂酶A2受体(PLA2R)抗体水平及与治疗效果的相关性。方法选取2018年1月至2019年1月石家庄市第一医院肾内科收治的100例肾病综合征患者为研究对象,分为IMN组41例、继发性膜性肾病组32例、非膜性肾病组27例。对3组患者在发病期、缓解期、活动期、复发期的抗PLA2R抗体阳性率进行比较,并对各组患者血清抗PLA2R抗体、24 h尿蛋白、血清清蛋白(Alb)、血清肌酐(Scr)水平进行比较。对各组患者进行治疗干预,根据治疗效果将膜性肾病患者分为缓解者和未缓解者,比较其血清抗PLA2R抗体水平及阳性率。采用Pearson相关分析IMN患者的抗PLA2R抗体与24 h尿蛋白、Alb、Scr及治疗缓解率的相关性。结果IMN组和继发性膜性肾病组患者在4个时期的抗PLA2R抗体阳性率均高于非膜性肾病组(P<0.05),且IMN组高于继发性膜性肾病组(P<0.05)。IMN组和继发性膜性肾病组抗PLA2R抗体、24 h尿蛋白、Scr水平高于非膜性肾病组(P<0.05),且IMN组高于继发性膜性肾病组(P<0.05);IMN组和继发性膜性肾病组Alb水平低于非膜性肾病组(P<0.05),且IMN组低于继发性膜性肾病组(P<0.05)。IMN、继发性膜性肾病中缓解者抗PLA2R抗体阳性率及水平均低于未缓解者(P<0.05)。IMN患者抗PLA2R抗体阳性率及水平与24 h尿蛋白、Scr呈正相关(P<0.05),与Alb、治疗缓解率呈负相关(P<0.05)。结论抗PLA2R抗体在IMN患者体内呈高表达,并与患者24 h尿蛋白、Alb、Scr及治疗效果呈明显的相关性,抗PLA2R抗体检测可为该病的鉴别诊断、病情评估提供参考。

Objective To study the correlation between serum anti-M-type phospholipase A2 receptor(PLA2R)antibody level and therapeutic effect in the patients with idiopathic membranous nephropathy(IMN).Methods One hundred patients with nephrotic syndrome treated in the nephrology department of Shijiazhuang Municipal First Hospital from January 2018 to January 2019 were selected as the study subjects and divided into the IMN group(n=41),secondary membranous nephropathy group(n=32)and non membranous nephropathy group(n=27).The positive rates of anti-PLA2R antibody at onset and during remission,active and relapse stages were detected and compared among 3 groups,and the levels of blood anti-PLA2R antibody,24 h urinary protein,serum albumin(Alb)and serum creatinine(Scr)were compared among the groups.The cases of each group conducted the treatment intervention,and the patients of membranous nephropathy divided into the remission group and non-remission group according to the therapeutic effect.The serum anti-PLA2R antibody levels and positive rates were compared between these two groups.The correlation between anti-PLA2R antibody level with 24 h urinary protein,Alb,Scr and treatment remission rate was analyzed by adopting the Pearson correlation.Results The positive rate of anti-PLA2R antibody during 4 periods in the IMN and secondary membranous nephropathy groups was higher than that in the non membranous nephropathy group(P<0.05),moreover the IMN group was higher than the secondary membranous nephropathy group(P<0.05).The levels of anti-PLA2R antibody,24 h urinary protein amount and Scr in the IMN and secondary membranous nephropathy groups were higher than those in the non membranous nephropathy group(P<0.05),moreover the IMN group was higher than the secondary membranous nephropathy group;The Alb level in the IMN and secondary membranous nephropathy groups was lower than that in the non membranous nephropathy groups(P<0.05),moreover the IMN group was lower than the secondary membranous nephropathy group(P<0.05).The positive rate and level of anti-PLA2R antibody in the remission patients of the IMN and secondary membranous nephropathy groups were lower than those in the patients with non-remission(P<0.05).The anti-PLA2R antibody positive rate and level in IMN patients were positively correlated with 24 h urinary protein and Scr(P<0.05),while negatively correlated with Alb level and treatment remission rate(P<0.05).Conclusion Anti-PLA2R antibody is highly expressed in the patients with IMN,which is significantly correlated with 24 h urinary protein,Alb,Scr and treatment effect.The detection of anti-PLA2R antibody can provide reference for the differential diagnosis and disease condition evaluation of IMN.