血清PLA2R抗体动态监测对特发性膜性肾病诊断及疗效评估的价值分析

Analysis of the value of dynamic monitoring of serum PLA2R antibody in the diagnosis and efficacy assessment of idiopathic membranous nephropathy

目的分析血清磷脂酶A2受体(PLA2R)抗体动态监测对特发性膜性肾病诊断及疗效评估的价值。方法200例特发性膜性肾病患者,根据血清PLA2R抗体水平分为对照组(抗体阴性)和实验组(抗体阳性),每组100例。将实验组根据滴度水平分为高滴度组(14例)、中滴度组(51例)和低滴度组(35例)。予以所有患者泼尼松联合他克莫司治疗。检测并比较实验组、对照组患者生化指标(血肌酐、血清白蛋白、血清总蛋白)、24 h尿蛋白定量、PLA2R抗体表达水平。比较高滴度组、中滴度组和低滴度组患者生化指标、24 h尿蛋白定量、PLA2R抗体表达水平及治疗效果,分析血清PLA2R抗体表达水平与生化指标、24 h尿蛋白定量的相关性。结果实验组血肌酐、24 h尿蛋白定量、PLA2R抗体表达水平分别为(75.37±3.51)μmol/L、(5.00±0.54)g/24 h、(54.09±1.58)RU/ml,高于对照组的(60.15±2.51)μmol/L、(4.07±0.01)g/24 h、(10.02±0.01)RU/ml,血清白蛋白、血清总蛋白水平分别为(28.49±3.15)、(49.84±4.56)g/L,低于对照组的(35.65±5.15)、(55.51±6.00)g/L,差异有统计学意义(P<0.05)。低滴度组、中滴度组、高滴度组患者的血肌酐、血清白蛋白、血清总蛋白、24 h尿蛋白定量、PLA2R抗体表达水平比较,差异有统计学意义(P<0.05)。中滴度组、高滴度组患者的血肌酐、24 h尿蛋白定量、PLA2R抗体表达水平高于低滴度组,血清白蛋白、血清总蛋白低于低滴度组;高滴度组患者的血肌酐、24 h尿蛋白定量、PLA2R抗体表达水平高于中滴度组,血清白蛋白、血清总蛋白低于中滴度组,差异有统计学意义(P<0.05)。低滴度组、中滴度组疾病缓解率分别为85.71%、78.43%,高于高滴度组的50.00%,差异有统计学意义(P<0.05)。低滴度组与中滴度组疾病缓解率比较,差异无统计学意义(P>0.05)。血清PLA2R抗体表达水平与血肌酐、24 h尿蛋白定量呈正相关(r=0.529、0.541,P=0.000、0.000<0.05),与血清白蛋白、血清总蛋白呈负相关(r=-0.391、-0.349,P=0.003、0.006<0.05)。结论特发性膜性肾病属于临床常见病,对其血清PLA2R抗体动态监测利于诊断病情及评估临床治疗效果,保证患者预后。

Objective To analyze the value of dynamic monitoring of serum phospholipase A2 receptor(PLA2R)antibody for the diagnosis of idiopathic membranous nephropathy and assessment of its efficacy.Methods A total of 200 patients with idiopathic membranous nephropathy were divided into a control group(antibody-negative)and an experimental group(antibody-positive)according to the serum PLA2R antibody level,with 100 cases in each group.The experimental group was divided into high titer group(14 cases),medium titer group(51 cases)and low titer group(35 cases)according to the titer level.All patients were treated with prednisone combined with tacrolimus.The biochemical indexes(blood creatinine,serum albumin,serum total protein),24-h urinary protein quantification,and PLA2R antibody expression levels of the patients in the experimental group and the control group were detected and compared.The biochemical indexes,24-h urinary protein quantification,PLA2R antibody expression level and therapeutic effect of patients in the high titer group,medium titer group and low titer group were compared,and the correlation of serum PLA2R antibody expression level with biochemical indexes and 24-h urinary protein quantification was analyzed.Results The levels of serum creatinine,24-h urinary protein quantification and PLA2R antibody expression level in the experimental group were(75.37±3.51)μmol/L,(5.00±0.54)g/24 h and(54.09±1.58)RU/ml,which were higher than those of(60.15±2.51)μmol/L,(4.07±0.01)g/24 h and(10.02±0.01)RU/ml in the control group;the levels of serum albumin and total serum protein in the experimental group were(28.49±3.15)and(49.84±4.56)g/L,which were lower than those of(35.65±5.15)and(55.51±6.00)g/L in the control group;the differences were statistically significant(P<0.05).There were statistically significant differences in serum creatinine,serum albumin,serum total protein,24-h urinary protein quantification and PLA2R antibody expression level among low titer group,medium titer group and high titer group(P<0.05).The serum creatinine,24-h urinary protein quantification and PLA2R antibody expression levels in medium titer group and high titer group were higher than those in low titer group,and the serum albumin and total serum protein were lower than those in low titer group;the serum creatinine,24-h urinary protein quantification and PLA2R antibody expression level in high titer group were higher than those in medium titer group,and the serum albumin and total serum protein were lower than those in medium titer group;the differences were statistically significant(P<0.05).The disease remission rates of low titer group and medium titer group were 85.71%and 78.43%,which were higher than that of 50.00%of high titer group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in disease remission rate between low titer group and medium titer group(P>0.05).The serum PLA2R antibody expression level was positively correlated with serum creatinine and 24-h urinary protein quantification(r=0.529,0.541;P=0.000,0.000<0.05),and negatively correlated with serum albumin and total serum protein(r=-0.391,-0.349;P=0.003,0.006<0.05).Conclusion Idiopathic membranous nephropathy is a common clinical disease,and dynamic monitoring of serum PLA2R antibody is beneficial to diagnose the disease and evaluate the clinical treatment effect,and ensure the prognosis of patients.