原发性膜性肾病患者血清25羟维生素D3与抗磷脂酶A2受体抗体滴度关系及联合检测意义探究

Relationship between serum 25-(OH)D3 and anti-PLA2R antibody titers in patients with primary membranous nephropathy and the significance of combined detection

目的探讨原发性膜性肾病(primary membranous nephropathy,PMN)患者血清25羟维生素D3[25-hydroxy vitamin D3,25-(OH)D3]、抗磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体滴度预测治疗反应性的价值及临床意义。方法选取石家庄市第一医院肾内科100例PMN患者,检测血清25-(OH)D3水平,根据血清25-(OH)D3水平分为正常组、降低组、缺乏组,比较各组基线资料,分析血清25-(OH)D3与患者24 h尿蛋白、抗PLA2R抗体滴度的相关性,并比较不同治疗反应性患者血清25-(OH)D3水平、抗PLA2R抗体滴度,分析血清25-(OH)D3联合抗PLA2R抗体滴度预测治疗反应性的价值。结果缺乏组24 h尿蛋白[(8.07±1.81)g比(6.28±1.76)g、(4.95±1.10)g]、抗PLA2R抗体滴度[(30.25±5.76)RU/mL比(23.96±4.85)RU/mL、(18.43±4.05)RU/mL]高于降低组、正常组,降低组24 h尿蛋白[(6.28±1.76)g比(4.95±1.10)g]、抗PLA2R抗体滴度[(23.96±4.85)RU/mL比(18.43±4.05)RU/mL]高于正常组(P<0.05);血清25-(OH)D3水平与24 h尿蛋白、抗PLA2R抗体滴度间存在负相关关系(P<0.05);经治疗,完全缓解患者血清25-(OH)D3水平[(23.64±6.95)μg/L比(18.03±6.17)μg/L、(11.88±3.74)μg/L]高于部分缓解、未缓解患者,部分缓解患者血清25-(OH)D3水平[(18.03±6.17)μg/L比(11.88±3.74)μg/L]高于未缓解患者(P<0.05);完全缓解患者血清抗PLA2R抗体滴度[(19.25±3.01)RU/mL比(24.86±3.25)RU/mL、(41.34±8.44)RU/mL]低于部分缓解、未缓解患者,部分缓解患者抗PLA2R抗体滴度[(24.86±3.25)RU/mL比(41.34±8.44)RU/mL]低于未缓解患者(P<0.001);血清25-(OH)D3联合抗PLA2R抗体滴度预测PMN患者治疗反应性为完全缓解的曲线下面积为0.913(95%CI:0.855~0.970),敏感度为90.91%,特异度为79.10%。结论血清25-(OH)D3水平与PMN患者24 h尿蛋白、抗PLA2R抗体滴度呈负相关,且血清25-(OH)D3联合抗PLA2R抗体滴度在预测PMN患者治疗反应性方面具有一定价值。

Objective To explore the value and clinical significance of serum 25-hydroxy vitamin D3[25-(OH)D3]and anti-phospholipase A2 receptor(PLA2R)antibody titers for predicting treatment responsiveness in patients with primary membranous nephropathy(PMN).Methods A total of 100 PMN patients were selected.Based upon serum 25-(OH)D3 level,they were divided into three groups of normal,declining and deficiency.The correlation between(OH)D3,24-h urine protein and anti-PLA2R antibody titer in patients and serum 25-(OH)D3 level and anti-PLA2R antibody titer in patients with different treatment responses were compared.Value of combination and anti-PLA2R antibody titers in predicting treatment responsiveness were analyzed.Results The 24 h urine protein[(8.07±1.81)g vs(6.28±1.76)g、(4.95±1.10)g]and anti-PLA2R antibody titers[(30.25±5.76)RU/mL vs(23.96±4.85)RU/mL、(18.43±4.05)RU/mL]in deficiency group were higher than those in reduced and normal groups and reduced group[(6.28±1.76)g vs(4.95±1.10)g、(23.96±4.85)RU/mL vs(18.43±4.05)RU/mL]was higher than normal group(P<0.05).There was a negative correlation between antibody titers(P<0.05);after treatment,serum 25-(OH)D3 level[(23.64±6.95)μg/L vs(18.03±6.17)μg/L、(11.88±3.74)μg/L]in patients with complete remission was higher than that in patients with partial remission and non-remission;patients with partial remission[(18.03±6.17)μg/L vs(11.88±3.74)μg/L]were higher than those in non-remission(P<0.05);Serum anti-PLA2R antibody titers[(19.25±3.01)RU/mL vs(24.86±3.25)RU/mL、(41.34±8.44)RU/mL]in complete remission patients were lower than those in partial remission and non-remission patients;anti-PLA2R antibody titers[(24.86±3.25)RU/mL vs(41.34±8.44)RU/mL]in partial remission patients were lower than those in non-remission patients(P<0.001);The area under the curve(AUC)of predicting complete remission in PMN patients was 0.913(95%CI:0.855-0.970)with a sensitivity of 90.91%and a specificity of 79.10%.Conclusion Serum 25-(OH)D3 level is negatively correlated with 24 h urine protein and anti-PLA2R antibody titers in PMN patients.And serum 25-(OH)D3 plus anti-PLA2R antibody titers has a certain value in predicting treatment response in PMN patients.