成人特发性膜性肾病血清抗PLA2R抗体有临床意义界值的单中心研究

Single-center Study of Serum Anti-PLA2R Antibodies in Adults with Idiopathic Membranous Nephropathy with Clinicalty Significant Cut-off Value

目的 探索保定市成人特发性膜性肾病(IMN)血清抗PLA2R抗体(sPLA2R-Ab)有临床意义的界值。方法纳入保定市第一中心医院2018年1月~2021年12月期间接受肾穿刺活检术并行sPLA2R-Ab检测的285例患者。根据肾穿刺活检的病理结果,分为IMN组、继发性膜性肾病(SMN)组和其他组,比较组间s PLA2R-Ab水平差异;分析IMN患者的s PLA2R-Ab水平与其他临床指标的相关性;采用Logistic回归鉴别发生IMN的危险因素;ROC曲线分析sPLA2R-Ab对IMN的诊断价值,并通过计算约登指数得出诊断IMN的sPLA2R-Ab最佳临界值。结果 IMN组的sPLA2R-Ab水平显著高于SMN组及其他组(P<0.05);IMN组的sPLA2R-Ab与总蛋白、白蛋白呈负相关(P<0.001),与24h尿蛋白定量、血肌酐、胆固醇正相关(P<0.05)。ROC曲线显示,sPLA2R-Ab诊断IMN患者的有临床意义的界值是3.315 RU/mL,相对应的Youden指数最高(0.651),敏感性为79.4%、特异性为85.7%,曲线下面积AUC为0.82(995%CI 0.776-0.882),P<0.001。结论 sPLA2R-Ab与IMN疾病的活动有关,鉴别IMN和非IMN患者的sPLA2R-Ab有临床意义的界值是3.315 RU/mL,这一新的界值可以提高IMN的早期诊断率。

Objective To explore the clinically significant cut-off value of serum anti-PLA2R antibody(sPLA2R-Ab)in adult idiopathic membranous nephropathy(IMN)in Baoding City.Methods A total of 285 patients who underwent renal needle biopsy and sPLA2R-Ab detection in Baoding First Central Hospital from Januaiy 2018 to December 2021 were included.The patients were divided into IMN groups,secondary membranous nephropathy(SMN)groups and other groins.The level of sPLA2R-Ab was compared between the groins;the coirelation between sPLA2R-Ab level and other clinical indicators in IMN patients was analyzed;logistic regression was plied to identify the riskctors of IMN;the diagnostic value of sPLA2R-Ab for IMN was analyzed by ROC curve,and Youden index was calculated to obtain the optimal cut­off value of sPLA2R-Ab for IMN diagnosis.Results The level of sPLA2R-Ab in IMN groups was significantly higher than that in SMN group and other groups(P<0.05).In IMN groip,sPLA2R-Ab was negatively correlated with total protein and albumin(P<0.001),it was positively correlated with 24h urinary protein,serum creatinine and cholestero(P<0.05).ROC curve showed that the cut-oflf value of sPLA2R-Ab in the diagnosis of IMN patients was 3.315RU/mL,the corresponding Vouden index was flie highest(0.651),the sensitivity was 79.4%,the specificity was 85.7%,the AUC was 0.829,P<0.001.Conclusion sPLA2R-Ab is associated with the activity of IMN disease.The cut-oflf value of SPLA2R-AB for diflferentialing IMN fiom non-IMN patients is 3.315RU/mL,which can iri^irove the eariy diagnosis rate of IMN.