血清抗磷脂酶A2受体抗体与特发性膜性肾病临床病理的关系及对疗效的影响

The study of correlation between serum anti-phospholipase A2 receptor antibody and clinicopathology feature and the efficacy in patients with idiopathic membranous nephropathy

目的探讨抗磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体与特发性膜性肾病(idopathic membranous nephropathy,IMN)临床病理的关系及对疗效的影响。方法将106例IMN患者依据血清抗PLA2R抗体分为抗PLA2R抗体阳性组(72例)与阴性组(34例),分析两组患者的临床病理特点;根据患者病情,给予泼尼松联合环磷酰胺或他克莫司治疗后,比较两组患者的疗效差异,并分析抗PLA2R抗体滴度与疗效的关系。结果抗PLA2R抗体阳性组较阴性组血清白蛋白低(t=10.353,P=0.012)、总胆固醇高(t=7.865,P=0.021)、尿蛋白量大(t=7.156,P=0.028)、基底膜厚(t=6.593,P=0.032)、缓解率低(χ2=7.370,P=0.007);泼尼松联合环磷酰胺或他克莫司治疗IMN二者缓解率差异无统计学意义(χ2=0.168,P=0.682);患者治疗前抗PLA2R抗体滴度与临床缓解高度相关(r=0.812,P=0.012)。结论血清抗PLA2R抗体滴度与IMN临床、病理密切相关,有助于判断病情,预测治疗反应。

Objective To assess the correlation between serum anti-phospholipase A2 receptor(PLA2R)antibody and clinicopathology and the effect of serum anti-phospholipase A2 receptor antibody on the patients with idiopathic membranous nephropathy(IMN).Methods According to the titers of anti-PLA2R antibody,106 patients were divided into the anti—PLA2R antibody positive group(72 patients)and negative group(34 patients).The clinicopathological characteristics of the two groups were analyzed.Depending on the patient's condition,prednisone combined with cyclophosphamide or tacrolimus was administered.The difference of therapeutic effect between the two groups was compared,and the correlation between titer of anti-PLA2R antibody and therapeutic effect was analyzed.Results The anti-PLA2R antibody positive group had lower serum albumin(t=10.353,P=0.012),higher total cholesterol(t=7.865,P=0.021),higher urinary protein quantification(t=7.156,P=0.028),thicker basement membrane(GBM)(t=6.593,P=0.032),and lower remission rate(χ2=7.370,P=0.007)than the negative group.There was no significant difference in the efficacy between prednisone combined with cyclophosphamide or tacrolimus(χ2=0.168,P=0.682)for IMN.The titer of anti-pla2r antibody before treatment was highly correlated with clinical remission rate in IMN patients(r=0.812,P=0.012).Conclusions Serum anti-PLA2R antibody is closely related to the clinicopathology of IMN,and helps to judge the disease and predict the treatment response.