抗磷脂酶A2受体抗体与原发性膜性肾病的临床特征和预后的相关性

Correlation between anti-PLA2R antibody levels and clinical features and prognosis of primary membranous nephropathy

目的探讨抗磷脂酶A2受体抗体(PLA2R-Ab)与原发性膜性肾病(PMN)患者临床特征和预后的相关性。方法本研究共纳入经肾穿刺活检确诊为PMN的患者137例。根据血清PLA2R-Ab滴度分为抗体阴性组(52例)和抗体阳性组(85例),2组的临床基线特征、临床缓解率及治疗前后的24 h尿蛋白、白蛋白(ALB)、血肌酐比较采用t检验或Mann-Whitney检验,并进行PLA2R-Ab与各临床指标间相关性分析。结果PLA2R-Ab阳性组患者的24 h尿蛋白定量较高(P<0.01),总蛋白(TP)和ALB较低(P<0.01),缓解率较低(P<0.05)。完全缓解和部分缓解患者的蛋白尿均显著下降(P<0.01),ALB显著上升(P<0.01),肾功能维持稳定水平,PLA2R-Ab水平随疾病的缓解显著下降(P<0.01)。PLA2R-Ab与TP、ALB呈负相关(P<0.01),与C4呈正相关(P<0.01)。结论血清PLA2R-Ab阳性的PMN患者临床表现较重,临床缓解率较低;PLA2R-Ab水平的变化与临床缓解情况密切相关,监测PLA2R-Ab变化对PMN的诊治及预后评估有重要价值。

Objective To investigate the correlation between anti-phospholipase A2 receptor antibody(PLA2R-Ab)levels and clinical features and the prognosis of patients with primary membranous nephropathy(PMN).Methods A total of 137 patients with biopsy-proven PMN were included and further classified into antibody-negative(52 cases)and antibody-positive(85 cases)groups.The clinical baseline features,clinical remission rates,and the changes in 24-h urine protein,albumin(ALB),and serum creatinine before and after treatment were compared between the two groups using t test and Mann-Whitney test.The correlation analyses of PLA2R-Ab with clinical baseline features were performed.Results The PLA2R-Ab-positive group demonstrated a higher 24-h urine protein(P<0.01),lower total albumin(TP)and ALB levels(P<0.01),and significantly lower remission rate(P<0.05)than the PLA2R-Ab-negative group.Proteinuria in patients in complete remission and partial remission decreased significantly(P<0.01),ALB increased significantly(P<0.01),and renal function remained stable.PLA2R-Ab levels decreased significantly with remission of disease(P<0.01).PLA2R-Ab was negatively correlated with TP and ALB(P<0.01)and positively correlated with C4(P<0.01).Conclusion Compared with the PLA2R-negative group,the PLA2R-positive group had severe clinical manifestations and a lower clinical treatment remission rate.The change in PLA2R antibody level was closely associated with clinical remission,and monitoring PLA2R-antibody is of great value for the diagnosis,treatment,and prognosis evaluation of PMN.