血清抗PLA2R抗体和尿EGF/MCP-1与特发性膜性肾病患者临床疗效和预后关系分析

Relationship of Serum Anti-PLA2R Antibody and Urine EGF/MCP-1 Ratio with Clinical Effect and Prognosis of Patients with Idiopathic Membranous Nephropathy

目的探讨血清抗磷脂酶A2受体(PLA2R)抗体和尿表皮生长因子(EGF)/单核细胞趋化蛋白-1(MCP-1)与特发性膜性肾病患者临床疗效和预后的关系。方法选取特发性膜性肾病104例,依据慢性肾脏疾病指南对其进行规范治疗,根据治疗6个月后临床效果将其分为完全缓解组(22例)、部分缓解组(64例)和未缓解组(18例)3组。比较3组治疗6个月后尿蛋白定量、尿白蛋白、肾小球滤过率、血清抗PLA2R抗体和尿EGF、MCP-1、EGF/MCP-1,以及随访预后良好和预后不良患者治疗6个月后血清抗PLA2R抗体和尿EGF/MCP-1;采用受试者工作特征(ROC)曲线分析血清抗PLA2R抗体、尿EGF/MCP-1及二者联合对特发性膜性肾病患者预后预测价值。结果治疗6个月后,3组尿蛋白定量、尿白蛋白、肾小球滤过率、血清抗PLA2R抗体和尿MCP-1、EGF/MCP-1总体比较差异均有统计学意义(P<0.01)。治疗6个月后,完全缓解组尿蛋白定量、血清抗PLA2R抗体和尿MCP-1低于未完全缓解组和未缓解组,尿白蛋白、肾小球滤过率及尿EGF/MCP-1高于未完全缓解组和未缓解组;未完全缓解组尿蛋白定量、血清抗PLA2R抗体和尿MCP-1低于未缓解组,尿白蛋白、肾小球滤过率及尿EGF/MCP-1高于未缓解组,差异有统计学意义(P<0.05或P<0.01)。58例特发性膜性肾病随访(6.75±1.48)个月,其中51例预后良好,7例预后不良,预后良好患者治疗6个月后血清抗PLA2R抗体低于预后不良患者,治疗6个月后尿EGF/MCP-1高于预后不良患者,差异有统计学意义(P<0.01)。ROC曲线分析结果显示,血清抗PLA2R抗体联合尿EGF/MCP-1对特发性膜性肾病患者预后预测价值最高,敏感度95.20%,特异度90.00%。结论临床疗效较好的特发性膜性肾病患者血清抗PLA2R抗体和尿MCP-1降低,尿EGF/MCP-1升高,血清抗PLA2R抗体联合尿EGF/MCP-1对特发性膜性肾病患者预后预测价值较高。

Objective To analyze the relationship of serum anti-phospholipase A2 receptor(PLA2R)antibody,urine epidermal growth factor(EGF)/monocyte chemoattractant protein 1(MCP-1)ratio with clinical effect and prognosis of patients with idiopathic membranous nephropathy(IMN).Methods A total of 104 patients with IMN were selected and treated according to the chronic kidney disease guidelines.According to the clinical effect after 6 months of treatment,they were divided into complete remission group(n=22),partial remission group(n=64)and non-remission group(n=18).Urinary protein quantification,urine albumin,glomerular filtration rate(GFR),serum anti-PLA2R antibodies,urine EGF,MCP-1,the EGF/MCP-1 ratio as well as serum anti-PLA2R antibodies,and urine EGF/MCP-1 ratio were compared in patients with poor prognosis and good prognosis at 6-month follow-up.Receiver operating characteristic(ROC)curve was used to analyze the prognostic value of serum anti-PLA2R antibodies,urine EGF/MCP-1 ratio and combination of the two in patients with IMN.Results At 6 months after treatment,there were statistically significant differences in the three groups with respect to urinary protein quantification,urine albumin,GFR,serum anti-PLA2R antibodies,urine MCP-1 and EGF/MCP-1 ratio(P<0.01).At 6 months after treatment,urinary protein quantification,serum anti-PLA2R antibody and urine MCP-1 in the complete remission group were lower,while urine albumin,GFR,and urine EGF/MCP-1 ratio were significantly higher than those in the incomplete remission group and the non-remission group.Urinary protein quantification,serum anti-PLA2R antibody and urine MCP-1 in the incomplete remission group were lower,while urine albumin,GFR and urine EGF/MCP-1 ratio were significantly higher than those in the non-remission group(P<0.05 or P<0.01).Fifty-eight patients with IMN were followed up for(6.75±1.48)months,of whom 51 patients had a good prognosis and 7 had a poor prognosis.In addition,at 6 months after treatment,serum anti-PLA2R antibody levels were significantly lower,whereas the EGF/MCP-1 ratio was significantly higher in IMN good prognosis group than in IMN poor prognosis group(P<0.01).ROC curve showed that combination of serum anti-PLA2R antibody and EGF/MCP-1 ratio had the highest diagnostic value in IMN patients(sensitivity 95.20%,specificity 90.00%).Conclusion In IMN patients with good clinical effect,serum anti-PLA2R antibodies and urine MCP-1 levels are reduced,and EGF/MCP-1 ratio is elevated.The combination of serum anti-PLA2R antibodies and urine EGF/MCP-1 ratio has a higher prognostic value in patients with IMN.