血清抗磷脂酶A2受体抗体阴性原发性膜性肾病患者血小板反应蛋白7A域的临床意义及其与预后的相关性分析

Clinical significance of thrombospondin in type 1 domain-containing 7A and its correlation with prognosis in patients of primary membranous nephropathy with negative serum anti-phospholipase A2 receptor antibodies

目的探讨血清抗磷脂酶A2受体(PLA2R)抗体阴性原发性膜性肾病(PMN)患者血小板反应蛋白7A域(THSD7A)的临床意义及其与预后的关系。方法纳入PMN患者323例,均行肾组织THSD7A及PLA2R抗原染色。根据肾组织抗原染色结果将103例血清抗PLA2R抗体阴性患者分为THSD7A相关膜性肾病组(THSD7A-MN组,76例)、PLA2R-MN组(7例)和未确定抗原的MN组(AU-MN组,20例)。收集所有患者的一般资料、实验室检查结果、肾组织病理特征及预后情况并分组进行比较。结果THSD7A-MN组患者血白蛋白水平显著高于PLA2R-MN组及AU-MN组;PLA2R-MN组患者肾小管萎缩面积占比低于AU-MN组(P<0.05)。PLA2R-MN组患者3个月、6个月、12个月部分缓解率、6个月及12个月完全缓解率均显著高于THSD7A-MN组;PLA2R-MN非免疫抑制治疗组3个月及6个月部分缓解率、12个月完全缓解率显著高于THSD7A-MN非免疫抑制治疗组(P<0.05)。结论THSD7A-MN在血清抗PLA2R抗体阴性PMN中患病率较低,其短期及长期治疗预后均不如PLA2R-MN。

Objective To investigate the clinical significance of thrombospondin in type 1 domain-containing 7A(THSD7A)and its relationship with prognosis in patients of primary membranous nephropathy(PMN)with negative serum anti-phospholipase A 2 receptor(PLA 2 R)antibodies.Methods A total of 323 PMN patients were included,and THSD7A and PLA2R antigen staining were performed in kidney tissue.According to the results of renal tissue antigen staining,103 patients with negative serum anti-PLA2R antibodies were divided into ThSD7A-associated membranous nephropathy group(THSD7A-MN group,76 cases),PLA2R-MN group(7 cases)and unidentified antigens MN group(AU-MN group,20 cases).General data,laboratory test results,renal histopathologic features and prognosis of all patients were collected and compared in groups.Results The serum albumin level of THSD7A-MN group was significantly higher than those in PLA2R-MN group and AU-MN group,the percentage of renal tubular atrophy area in PLA2R-MN group was lower than that in AU-MN group(P<0.05).The 3-month,6-month,12-month partial response rate and 6-month,12-month complete response rate in PLA2R-MN group were significantly higher than those in THSD7A-MN group;the 3-month,6-month partial response rate and 12-month complete response rate of PLA2R-MN non-immunosuppressive treatment group were significantly higher than those in THSD7A-MN non-immunosuppressive treatment group(P<0.05).Conclusion THSD7A-MN has a lower prevalence in serum anti-PlA2R antibody negative PMN,and its short and long term treatment prognosis is worse than that in PLA2R-MN.