特发性膜性肾病治疗中抗M型磷脂酶A2受体抗体的临床意义和指导价值

Clinical significance and guiding value of anti-M-type phospholipase A2 receptor antibody in the treatment of idiopathic membranous nephropathy

目的 观察特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者免疫治疗中血清抗M型磷脂酶A2受体(M-type phospholipase A2 receptor antibody,anti-PLA2R)抗体的表达情况及与疗效相关性。方法 选取2017年1月至2019年1月期间收治100例经肾活检确诊IMN患者,通过间接免疫荧光法对患者血清抗antiPLA2R抗体进行检测,依据血清抗anti-PLA2R抗体的检测结果分为抗anti-PLA2R抗体阳性组(研究组,n=68)、抗anti-PLA2R抗体阴性组(对照组,n=32),患者均予以激素结合环磷酰胺方案进行治疗。比较分析治疗前后两组患者血清白蛋白、24 h尿蛋白、血肌酐、肾小球滤过率(eGFR)及抗anti-PLA2R抗体转阴情况。结果 治疗3~12个月后研究组患者24 h尿蛋白水平相比对照组显著更高(t=2.563、2.581、7.990、8.982,P=0.012、0.000、0.000、0.000);治疗3~12个月后研究组患者血清白蛋白水平相比对照组显著更低(t=9.248、12.001、13.410、16.226,P=0.000、0.000、0.000、0.000);研究组患者治疗6个月后缓解率相比对照组显著更低(χ^(2)=9.224,P=0.002);研究组患者治疗12个月后缓解率相比对照组显著更低(χ^(2)=18.301,P=0.000);研究组患者治疗12个月后复查抗antiPLA2R抗体提示阳性35例,阳性率51.47%;两组治疗后不良反应率比较差异无统计学意义(χ^(2)=0.000,P=1.000)。结论 血清抗anti-PLA2R抗体检测阳性患者的免疫治疗效果相比检测阴性者更差,血清抗anti-PLA2R抗体检测有助于判断IMN患者病情与临床治疗效果。

Objective To observe the expression of anti-M-type phospholipase A2 receptor antibody(anti-PLA2R)in the immunotherapy of patients with idiopathic membranous nephropathy(IMN)and its correlation with the efficacy.Methods A total of 100 patients admitted to hospital with IMN confirmed by renal biopsy from January 2017 to January 2019 were selected.The serum anti-anti-PLA2R antibodies were detected by indirect immunofluorescence method.According to the detection results,patients were divided into the anti-anti-PLA2R antibody positive group(the study group,n=68)and the anti-anti-PLA2R antibody negative group(the control group,n=32).All patients were treated with hormone combined with cyclophosphamide.The serum albumin,24-h urine protein,blood creatinine,estimated glomerular filtration rate(eGFR),and anti-anti-PLA2R antibody negative conversion in the two groups before and after treatment were compared and analyzed.Results After 3 to 12 months of treatment,the levels of 24-h urine protein in patients of the study group were significantly higher than those of the control group(t=2.563,2.581,7.990,8.982,P=0.012,0.000,0.000,0.000).After 3 to 12 months of treatment,the levels of serum albumin in patients of the study group were significantly lower than those of the control group(t=9.248,12.001,13.410,16.226,P=0.000,0.000,0.000,0.000).The remission rate in the study group was significantly lower than that in the control group after 6 months of treatment(χ^(2)=9.224,P=0.002).In addition,the remission rate in the study group was significantly lower than that in the control group(χ^(2)=18.301,P=0.000).The patients in the study group were reexamined with anti-anti-PLA2R antibodies after 12 months of treatment and 35 patients were positive,with a positive rate of 51.47%.There was no significant difference between the two groups in the rate of adverse reactions after treatment(χ^(2)=0.000,P=1.000).Conclusion Patients with positive serum anti-anti-PLA2R antibody detection has worse immunotherapeutic effect compared with those with negative detection,and serum anti-anti-PLA2R antibody detection is conducive to determining the condition and clinical efficacy of IMN patients.