血清抗磷脂酶A2受体抗体在诊断成人原发性膜性肾病中的意义

Significance of serum anti phospholipase A2 receptor antibody in diagnosis of adult primary membranous nephropathy

目的通过研究抗磷脂酶A2受体(PLA2R)抗体在不同肾脏疾病患者中的表达,为临床诊断成人特发性膜性肾病(IMN)提供依据。方法分别收集膜性肾病患者、其他肾脏疾病患者和健康体检者50例、28例、10例,检测PLA2R抗体及其他实验室指标。分析PLA2R抗体在不同组别的阳性率、滴度水平和PLA2R抗体与其他实验室指标的相互关系。结果PLA2R抗体在IMN组中阳性率为54%,与疾病对照组和健康对照组比较差异有统计学意义(P<0.05),抗体水平中位数为45.774 RU/ml,在不同组别间的差异有统计学意义(P<0.05)。PLA2R抗体对IMN诊断敏感度为54%,特异度为100%,阳性预测值为100%,阴性预测值为62.3%,诊断准确率为73.9%,ROC曲线下面积为0.798。IMN患者PLA2R抗体阳性组和阴性组血清ALB和尿液PRO、MA和TRU的差异有统计学意义(P<0.05)。结论PLA2R抗体在IMN组中阳性率、滴度高,阳性者较抗体阴性者更容易出现低蛋白血症和蛋白尿。通过检测血清PLA2R抗体水平,可有效诊断IMN并为患者的肾功能评估提供参考依据。

Objective To study the expression of anti-phospholipase A2 receptor(PLA2 R)antibody in patients with different renal diseases,so as to provide basis for clinical diagnosis of adult idiopathic membranous nephropathy(IMN).Methods Fifty patients with membranous nephropathy,twenty eight patients with other renal diseases and ten healthy people were collected to detect PLA2 R antibody and other laboratory indexes.The positive rate and titer of PLA2 R antibody in different groups and the relationship between PLA2 R antibody and other laboratory indexes were analyzed.Results The positive rate of PLA2 R antibody in IMN group was 54%,and the difference was statistically significant compared with disease control group and healthy control group(P<0.05);the median antibody level was 45.774 RU/ml,the difference was statistically significant between different groups(P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of PLA2 R antibody in the diagnosis of IMN were 54%,100%,100%and 62.3%,respectively.The diagnostic accuracy was 73.9 and the area under ROC curve was 0.798.There was statistical significance on the differences in serum ALB and urine PRO,MA and TRU between positive and negative PLA2 R antibody groups(P<0.05).Conclusion The positive rate and titer of PLA2 R antibody in IMN group are high,and the patients with positive PLA2 R antibody are more likely to have hypoproteinemia and proteinuria than those with negative PLA2 R antibody.The detection of serum PLA2 R antibody level can effectively diagnose IMN and provide reference for the evaluation of renal function.