血清抗PLA2R抗体和sST2在特发性膜性肾病中的水平及临床意义

Levels and clinical significance of serum anti-PLA2R antibody and sST2 in idiopathic membranous nephropathy

目的探讨特发性膜性肾病(IMN)患者血清抗磷脂酶A2受体(PLA2R)抗体、可溶性致癌抑制因子2(sST2)水平与病情的关系。方法选取2018年1月至2019年12月该院肾内科收治的110例肾病综合征患者作为研究对象,按病理诊断分为IMN组(78例)和非IMN组(32例),另选取同期30例健康体检者作为对照组,所有IMN患者进行病理分期,整理临床资料进行统计分析;采用量子点荧光免疫法及酶联免疫吸附试验检测血清抗PLA2R抗体和sST2水平。结果IMN组血清抗PLA2R抗体水平明显高于非IMN组和对照组,IMN组和非IMN组血清sST2水平均明显高于对照组,差异均有统计学意义(P<0.05)。受试者工作特征曲线(ROC曲线)分析结果显示,血清抗PLA2R抗体联合sST2检测对IMN的诊断价值最高,灵敏度为76.9%,特异度为98.4%,ROC曲线下面积为0.913。不同抗PLA2R抗体滴度水平IMN患者中,抗体滴度水平越高者,其血清清蛋白水平越低,尿蛋白定量水平越高,差异均有统计学意义(P<0.05)。血清sST2水平与血清清蛋白水平呈负相关,与尿蛋白定量水平呈正相关。4种病理分期IMN患者抗PLA2R抗体、sST2水平比较,差异均有统计学意义(P<0.05)。结论IMN患者血清抗PLA2R抗体、sST2水平均高于健康人群,抗PLA2R抗体联合sST2检测对IMN有较高的诊断价值和病情评估价值。

Objective To investigate the relationship between the levels of anti-phospholipase A2 receptor(PLA2R)antibody and soluble suppression of tumorigenicity 2(sST2)with the condition of idiopathic membranous nephropathy(IMN).Methods A total of 110 patients with nephrotic syndrome admitted to the department of nephrology of the hospital from January 2018 to December 2019 were selected as the research subjects.According to the pathological diagnosis,they were divided into IMN group(78 cases)and non-IMN group(32 cases),and 30 healthy subjects underwent physical examination during the same period were selected as the control group.All IMN patients underwent pathological staging,and the clinical data were sorted for statistical analysis.Serum anti-PLA2R antibody and sST2 levels were detected by quantum dot fluorescence immunoassay and enzyme-linked immunosorbent assay.Results The serum anti-PLA2R antibody level in the IMN group was significantly higher than that in the non-IMN group and the control group,and the serum sST2 level in the IMN group and the non-IMN group was significantly higher than that in the control group,the differences were statistically significant(P<0.05).Receiver operating characteristic curve(ROC curve)analysis showed that serum anti-PLA2R antibody combined with sST2 detection had the highest diagnostic value in IMN,with a sensitivity of 76.9%,a specificity of 98.4%,and an area under the ROC curve of 0.913.Among the IMN patients with different anti-PLA2R antibody titers,the higher the antibody titer,the lower the serum albumin level and the higher the urinary protein quantification level,and the differences were statistically significant(P<0.05).Serum sST2 level was negatively correlated with serum albumin level and positively correlated with urinary protein quantitative level.There were significant differences in the levels of anti-PLA2R antibody and sST2 in patients with four pathological stages of IMN(P<0.05).Conclusion The serum levels of anti-PLA2R antibody and sST2 in patients with IMN are higher than those in healthy people.The detection of anti-PLA2R antibody combine with sST2 has higher diagnostic value and disease evaluation value in IMN.