摘要
目的探讨抗M型磷脂酶A2受体(PLA2R)IgG4抗体和PLA2R IgG4/IgG比值在原发性膜性肾病(PMN)预后评估中的价值。方法选取2020年1月—2022年12月南阳市第一人民医院PMN患者58例。收集所有患者临床资料、病理检查资料和实验室检测结果,并检测血清抗PLA2R IgG抗体和抗PLA2R IgG4抗体水平,计算PLA2R IgG4/IgG比值。对所有患者随访3~24个月,根据疗效分为缓解组和未缓解组。采用Pearson/Spearman相关分析评估各项指标之间的相关性。采用Kaplan-Meier生存曲线分析不同抗PLA2R IgG4抗体水平和PLA2R IgG4/IgG比值PMN患者的缓解率。结果58例PMN患者中,PLA2R阳性51例(87.93%)、阴性7例(12.07%)。PLA2R阳性组血清抗PLA2R IgG抗体、抗PLA2R IgG4抗体和PLA2R IgG4/IgG比值均高于PLA2R阴性组。PLA2R与抗PLA2R IgG4抗体、PLA2R IgG4/IgG比值均呈正相关(r值分别为0.276、0.283,P<0.05)。抗PLA2R IgG抗体和抗PLA2R IgG4抗体与红细胞沉降率(ESR)均呈正相关(r值分别为0.283、0.382,P<0.05),抗PLA2R IgG抗体和抗PLA2R IgG4抗体与高密度脂蛋白胆固醇(HDL-C)均呈负相关(r值分别为-0.379、-0.425,P<0.05)。抗PLA2R IgG4抗体与抗PLA2R IgG抗体、PLA2R IgG4/IgG比值均呈正相关(r值分别为0.817、0.714,P<0.001)。规范治疗并随访3~24个月后,58例PMN患者中有41例(70.69%)缓解。缓解组治疗前、后24 h尿蛋白、抗PLA2R IgG抗体、抗PLA2R IgG4抗体和PLA2R IgG4/IgG比值均显著低于未缓解组(P<0.05)。治疗后缓解组血清白蛋白(Alb)水平高于未缓解组(P<0.001)。Kaplan-Meier生存曲线分析结果显示,低抗PLA2R IgG4抗体水平和低PLA2R IgG4/IgG比值PMN患者缓解率分别高于高抗PLA2R IgG4抗体水平和高PLA2R IgG4/IgG比值PMN患者。结论抗PLA2R IgG4抗体和PLA2R IgG4/IgG比值或可作为评估PMN疗效的指标。
Objective To investigate the roles of anti-M-type phospholipase A2 receptor(PLA2R)IgG4 antibody and PLA2R IgG4/IgG ratio in prognostic assessment of primary membranous nephropathy(PMN).Methods Totally,58 PMN patients from Nanyang First People's Hospital from January 2020 to December 2022 were enrolled.The clinical data,pathological examination data and clinical laboratory determination results of all the patients were collected,and serum levels of anti-PLA2R IgG antibody and anti-PLA2R IgG4 antibody were determined to calculate PLA2R IgG4/IgG ratio.All the patients were followed up for 3-24 months and were classified into remission group and non-remission group based on the efficacy.The correlation between various indicators was evaluated by Pearson/Spearman correlation analysis.The remission rate of PMN patients with different levels of anti-PLA2R IgG4 antibody and PLA2R IgG4/IgG ratio was evaluated by Kaplan-Meier survival curve.Results Among the 58 PMN patients,51(87.93%)cases were PLA2R positive,and 7(12.07%)cases were negative.Serum anti-PLA2R IgG antibody,anti-PLA2R IgG4 antibody and PLA2R IgG4/IgG ratio in PLA2R positive group were higher than those in PLA2R negative group(P).PLA2R was positively correlated with anti-PLA2R IgG4 antibody and PLA2R IgG4/IgG ratio(r=0.276 and 0.283,P<0.05).Anti-PLA2R IgG antibody and anti-PLA2R IgG4 antibody were positively correlated with erythrocyte sedimentation rate(ESR)(r=0.283 and 0.382,P<0.05),while anti-PLA2R IgG antibody and anti-PLA2R IgG4 antibody were negatively correlated with high-density lipoprotein cholesterol(HDL-C)(r=-0.379 and-0.425,P<0.05).Anti-PLA2R IgG4 antibody was positively correlated with anti-PLA2R IgG antibody and PLA2R IgG4/IgG ratio(r=0.817 and 0.714,P<0.001).After standardized treatment and follow-up for 3-24 months,41 out of 58 PMN patients(70.69%)experienced remission.Urinary protein,anti-PLA2R IgG antibody,anti-PLA2R IgG4 antibody and PLA2R IgG4/IgG ratio in remission group before and 24 h after treatment were lower than those in non-remission group(P<0.05).After treatment,serum albumin(Alb)level in remission group was higher than that in non-remission group(P<0.001).Kaplan-Meier survival curve analysis results showed that patients with low anti-PLA2R IgG4 antibody levels and low PLA2R IgG4/IgG ratio had higher remission rates than those with high anti-PLA2R IgG4 antibody levels and high PLA2R IgG4/IgG ratio,respectively.Conclusions Anti-PLA2R IgG4 antibody and PLA2R IgG4/IgG ratio may serve as the indicators for evaluating the efficacy of PMN treatment.
作者
孙林成
李建锋
程维丽
姬攀云
SUN Lincheng;LI Jianfeng;CHENG Weili;JI Panyun(Department of Nephrology,Nanyang First People's Hospital,Nanyang 473000,Henan,China)
出处
《检验医学》
CAS
2023年第12期1115-1120,共6页
Laboratory Medicine