血清抗M型磷脂酶A2受体抗体对特发性膜性肾病的诊断价值

Diagnostic value of serum anti-M type phospholipase A2 receptor antibody in idiopathic membranous nephropathy

目的研究血清抗M型磷脂酶A2受体(PLA2R)抗体对特发性膜性肾病(IMN)的诊断价值。方法回顾性分析纳入2019年1月至2020年1月于南京医科大学第一附属医院住院且经肾组织活检病理诊断为IMN的75例患者的临床资料(IMN组)。另选取同期于本院住院治疗的35例非IMN的肾病患者(非IMN组)。采用酶联免疫吸附试验法(ELISA)检测患者血清抗PLA2R抗体。比较2组血清、尿液中生化及免疫指标水平。结果IMN组血清抗PLA2R抗体水平、抗PLA2R抗体阳性率均显著高于非IMN组[101.30(56.90,219.80)RU/ml比1.36(1.24,8.34)RU/ml、97.3%(73/75)比11.4%(4/35)](均P<0.01)。2组血清总蛋白、白蛋白、免疫球蛋白G(IgG)、IgA、IgM、补体C3、补体C4及尿游离κ轻链、尿游离λ轻链水平比较,差异均无统计学意义(均P>0.05)。Pearson相关性分析结果显示,IMN患者血清抗PLA2R抗体与尿游离κ轻链、尿游离λ轻链呈正相关(均P<0.01)。结论IMN患者血清抗PLA2R抗体水平显著升高,可作为特异性血清学检测指标。

Objective To explore the diagnostic value of serum anti-M type phospholipase A2 receptor(PLA2 R)antibody in idiopathic membranous nephropathy(IMN).Methods From January 2019 to January 2020,clinical data of 75 patients with IMN(IMN group)admitted to the First Affiliated Hospital of Nanjing Medical University who were diagnosed by renal biopsy pathology were retrospectively analyzed.Another 35 nephrosis inpatients without IMN(non-IMN group)were enrolled.Enzyme linked immunosorbent assay was used to detected serum level of anti-PLA2 R antibody.Biochemical and immune indexes in serum or urine were compared between the two groups.Results The serum level of anti-PLA2 R antibody and positive rate of anti-PLA2 R antibody in IMN group were higher than those in non-IMN group[101.30(56.90,219.80)RU/ml vs 1.36(1.24,8.34)RU/ml,97.3%(73/75)vs 11.4%(4/35)](both P<0.01).There were no significant differences in serum levels of total protein,albumin,immunoglobulin G(IgG),IgA,IgM,complement C3,complement C4,and levels of freeκlight chain and freeλlight chain in urine between the two groups(all P>0.05).Pearson correlation analysis showed that serum level of anti-PLA2 R antibody was positively correlated with freeκlight chain and freeλlight chain in urine in patients with IMN(both P<0.01).Conclusion The serum level of anti-PLA2 R antibody increases in patients with IMN,which could be used as a specific indicator for serological detection for IMN.