特发性膜性肾病患者磷脂酶A2受体抗体与肾脏病理的关系

The relationship between phospholipase A2 receptor antibody and renal pathology in patients with idiopathic membranous nephropathy

目的研究特发性膜性肾病(IMN)患者磷脂酶A2受体(PLA2R)抗体与肾脏病理的关系,评估血清PLA2R抗体在IMN患者疾病监测中的应用价值。方法选取2018年2月至2019年3月经肾脏病理活检明确诊断为IMN的患者35例,设为IMN组;选取同期住院行肾脏病理活检的非IMN患者33例,设为非IMN组。收集入选患者的临床生化、血清免疫球蛋白、血清抗PLA2R抗体、肾小球PLA2R抗原染色及免疫组化等指标,分析IMN患者血清PLA2R抗体与肾脏病理之间的关系。结果IMN组24h尿蛋白定量明显高于非IMN组,血浆白蛋白明.显低于非IMN组(P<0.05);两组血肌酐、血尿素氮、血胱抑素水平比较,差异无统计学意义(P>0.05);IMN组血清胆固醇水平明显高于非IMN组(P<0.05),而三酰甘油水平比较,两组差异无统计学意义(P>0.05);IMN组血清IgG、IgM水平明显低于非IMN组(P<0.05),而两组血清IgA水平比较,差异无统计学意义(P>0.05);IMN组C3水平高于非IMN组(P<0.05),而两组血清C4水平比较,差异无统计学意义(P>0.05)。IMN组患者血清PLA2R抗体与肾小球PLA2R联合检测结果两者全部阳性者占68.6%(24/35),全部阴性者占5.7%(2/35),血清PLA2R抗体阳性而肾小球PLA2R阴性者占5.7%(2/35),血清PLA2R抗体阴性而肾小球PLA2R阳性者占20.0%(7/35);血清PLA2R抗体对IMN诊断的灵敏度为74.3%,特异度为100.0%;肾小球PLA2R抗原对IMN诊断的灵敏度为88.6%,特异度为100.0%。结论血清PLA2R抗体水平检测措施简单方便,对IMN患者血清PLA2R抗体水平的动态监测观察,可为病情评估提供一定的参考,对治疗方案的制定有重要意义。

Objective To study the relationship between serum PLA2R antibody and renal pa-thology in patients with idiopathic membranous nephropathy(IMN),and to evaluate the value of ser-um PLA2R antibody in the follow-up of IMN patients.Methods Thirty-five patients with IMN con-firmed by renal biopsy.The control group included thirty-three patients with non-IMN who underwent renal pathological biopsy.The laboratory values,such as serum immunoglobulin,serum anti PLA2R an-tibody,glomerular PLA2R antigen staining and immunohistochemistry were collected to analyze the re-lationship between serum PLA2R antibody and renal pathology in IMN patients.Results The sensi-tivity and specificity of serum PLA2R antibody detection for IMN diagnosis were 74.3%and 100.0%,respectively.Combined detection of serum PLA2R antibody and glomerular PLA2R in IMN patients:both positive was 68.6%,both negative was 5.7%,the former positive and the latter negative was 5.7%,the former negative and the latter positive was 20%.There were two patients with IMN,their se-rum PLA2R antibodies were 247.24 RU/mL and 197.75 RU/mL,respectively.After receiving hemo-dialysis due to the end stage of renal disease(ESRD),serum PLA2R antibody was reduced to normal(0.71 RU/mL)in the patient without urine,while remained high level(230.15 RU/mL)in another patient with normal urine volume.In the two patients with IMN before kidney transplantation,and with normal range of renal function and proteinuria after renal transplantation,the serum PLA2R antibody levels were also normal(0.76 RU/mL and 0.98 RU/mL,respectively).Conclusions The detection of serum PLA2R antibody level is simple and convenient.The dynamic monitoring of serum PLA2R an-tibody level can provide a meaningful reference value jn the follow-up of IMN patients,and is helpful in formulation a reasonable therapeutic regimen.