血清抗M型磷脂酶A2受体抗体在特发性膜性肾病治疗的价值分析

Value Analysis of Serum Anti-M-type Phospholipase A2 Receptor Antibody in the Treatment of Idiopathic Membranous Nephropathy

目的探讨血清抗M型磷脂酶A2受体(PLA2R)抗体在特发性膜性肾病治疗中的临床价值。方法便利选取2018年1月—2019年1月该院肾内科收治的行肾活检的43例IMN患者进行回顾性分析,根据抗PLA2R抗体滴度检测结果将其分成3组,即高滴度组(n=13)、中滴度组(n=12)及低滴度组(n=18)。所有患者给予环磷酰胺及足量激素联合治疗,测定3组患者在治疗前后的血清白蛋白水平和24 h尿蛋白水平,分析治疗后患者的临床完全缓解率和部分缓解率。结果低滴度组患者在治疗1个月、3个月及6个月后的血清白蛋白水平分别为(28.7±3.32)g/L、(36.5±3.22)g/L、(38.4±1.95)g/L均明显高于中滴度组和高滴度组,且24 h尿蛋白水平分别为(3.37±0.87)g、(1.28±0.36)g、(0.34±0.11)g均低于中滴度组和高滴度组(P<0.05)。低滴度组患者在治疗1个月、3个月及6个月后的总缓解率为55.56%、88.89%、94.44%均明显高于中滴度组和高滴度组(P<0.05)。结论血清抗PLA2R抗体滴度在IMN患者的治疗中与其临床疗效呈负相关,因此可作为评价临床疗效的敏感性血清学指标。

Objective To investigate the clinical value of serum anti-M-type phospholipase A2 receptor(PLA2 R) antibodies in the treatment of idiopathic membranous nephropathy. Methods A retrospective analysis of Convenient selection 43 patients with IMN who underwent renal biopsy admitted to the Department of Nephrology in the hospital from January 2018 to January 2019 was carried out. According to the results of anti-PLA2 R antibody titers, they were divided into three groups, namely the high titer group(n=13), middle titer group(n=12) and low titer group(n=18). All patients were treated with cyclophosphamide and sufficient hormones. The serum albumin levels and 24-hour urine protein levels of the three groups of patients before and after treatment were measured, and the clinical complete remission rate and partial remission rate of the patients after treatment were analyzed. Results The serum albumin levels of patients in the low titer group were(28.7±3.32)g/L,(36.5 ±3.22)g/L, and(38.4 ±1.95)g/L after 1, 3, and 6 months of treatment, were significantly higher than the middle and high titer groups, and the 24-hour urine protein levels were(3.37 ±0.87)g,(1.28±0.36) g, and(0.34±0.11) g respectively, lower than the middle titer group and high titer group(P <0.05). Patients in the low titer group had a total remission rate of 55.56%, 88.89%, and 94.44% after 1 month, 3 months and 6 months of treatment, which were significantly higher than those of the medium titer group and the high titer group(P<0.05). Conclusion The serum anti-PLA2 R antibody titer is negatively correlated with its clinical efficacy in the treatment of IMN patients, so it can be used as a sensitive serological index for evaluating clinical efficacy.