外周血PLA2R抗体、25(OH)D_(3)、ADAMTS13与原发性膜性肾病患者病情、肾功能损伤的关系

Relationship between peripheral blood PLA2R antibody,25(OH)D_(3),ADAMTS13 in patients with primary membranous nephropathy and the severity of disease and renal function damage

目的探讨原发性膜性肾病患者外周血M型磷脂酶A2受体(PLA2R)抗体、25羟维生素D_(3)[25(OH)D_(3)]、血管性血友病因子裂解酶13(ADAMTS13)与其病情程度及肾功能损伤的关系。方法选取2021年1月至2023年1月该院收治的122例原发性膜性肾病患者作为研究对象,所有患者均经肾穿刺活检病理检查确诊,根据病理分期结果分为1期组(55例)、2期组(24例)、3期组(43例)。另选同期于本院体检的40例健康者作为健康组。所有患者均随访6个月,并评价患者肾功能情况,患者24 h尿蛋白量减少≥50%、水肿症状减轻或消失,纳入良好组,其余纳入不良组。比较1期组、2期组、3期组、健康组研究指标[PLA2R抗体、25(OH)D_(3)、ADAMTS13活性]、肾功能指标(24 h尿蛋白、ALB)水平。采用Pearson相关分析PLA2R抗体、25(OH)D_(3)水平、ADAMTS13活性与24 h尿蛋白、ALB水平的关系。比较良好组与不良组的PLA2R抗体、25(OH)D_(3)水平、ADAMTS13活性。绘制受试者工作特征(ROC)曲线分析PLA2R抗体、25(OH)D_(3)、ADAMTS13单独及3项指标联合检测对原发性膜性肾病患者肾功能损伤的预测价值。结果PLA2R抗体、24 h尿蛋白水平为3期组>2期组>1期组>健康组,且任意两组间比较,差异均有统计学意义(P<0.05)。25(OH)D_(3)水平、ADAMTS13活性、ALB水平比较,3期组<2期组<1期组<健康组,差异均有统计学意义(P<0.05)。Pearson相关分析结果显示,PLA2R抗体水平与24 h尿蛋白水平呈正相关(r=0.620,P<0.05);25(OH)D_(3)水平、ADAMTS13活性与24 h尿蛋白水平均呈负相关(r=-0.625、-0.607,P<0.05);PLA2R抗体水平与ALB水平呈负相关(r=-0.591,P<0.05);25(OH)D_(3)水平、ADAMTS13活性与ALB水平均呈正相关(r=0.742、0.899,P<0.05)。良好组患者63例,不良组患者59例。良好组PLA2R抗体水平低于不良组,而25(OH)D_(3)水平、ADAMTS13活性均高于不良组,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,PLA2R抗体、25(OH)D_(3)、ADAMTS13单独检测预测原发性膜性肾病患者肾功能损伤的曲线下面积分别为0.831、0.836、0.713,均低于3项指标联合检测预测原发性膜性肾病患者肾功能损伤的0.860(P<0.05)。结论原发性膜性肾病患者外周血PLA2R抗体水平会随着患者疾病恶化而逐渐升高,而25(OH)D_(3)水平、ADAMTS13活性会随病情加重而逐渐降低,且3项指标联合检测对原发性膜性肾病患者肾功能损伤有较高预测价值。

Objective To investigate the relationship between the activity of M-type phospholipase A2 receptor(PLA2R)antibody,25-hydroxyvitamin D_(3)[25(OH)D_(3)],von willebrand factor cleaving enzyme 13(ADAMTS13)in peripheral blood of patients with primary membranous nephropathy and the severity of disease and renal function damage.Methods A total of 122 patients with primary membranous nephropathy admitted to the hospital from January 2021 to January 2023 were selected as research subjects.All patients were diagnosed by renal biopsy pathological examination.According to the pathological staging results,they were divided into stage 1 group(55 cases),stage 2 group(24 cases),and stage 3 group(43 cases).In addition,40 healthy people who underwent physical examination in the hospital during the same period were selected as the healthy group.All patients were followed up for 6 months,and the renal function of patients was evaluated and patients with a reduction of 24 h urinary protein≥50%and edema symptoms were relieved or disappeared were included in the good group,and the rest were included in the poor group.The levels of study indexes[PLA2R antibody,25(OH)D_(3) level,ADAMTS13 activity]and renal function indexes(24 h urinary protein,ALB level)were compared among the stage 1 group,stage 2 group,stage 3 group and healthy group.Pearson correlation analysis was used to analyze the relationship between PLA2R antibody,25(OH)D_(3) level,ADAMTS13 activity and 24 h urinary protein and ALB levels.The levels of PLA2R antibody,25(OH)D_(3) level and ADAMTS13 activity were compared between the good group and the poor group.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of PLA2R antibody,25(OH)D_(3),ADAMTS13 alone and combined detection of the three indicators for renal function in patients with primary membranous nephropathy.Results The levels of PLA2R antibody and 24 h urinary protein in the stage 3 group>stage 2 group>stage 1 group>healthy group,and the differences between two-by-two comparisons were statistically significant(P<0.05).The levels of 25(OH)D_(3),ADAMTS13 activity and ALB in the stage 3 group<stage 2 group<stage 1 group<healthy group,and the differences between two-by-two comparisons were statistically significant(P<0.05).Pearson correlation analysis showed that the level of PLA2R antibody was positively correlated with the level of 24 h urinary protein(r=0.620,P<0.05).Serum 25(OH)D_(3) level and ADAMTS13 activity were negatively correlated with 24 h urinary protein level(r=-0.625,-0.607,P<0.05).PLA2R antibody level was negatively correlated with ALB level(r=-0.591,P<0.05).Serum 25(OH)D_(3) level and ADAMTS13 activity were positively correlated with ALB level(r=0.742,0.899,P<0.05).There were 63 patients in good group,and 63 patients in poor group.The level of PLA2R antibody in the good group was lower than that in the poor group,and the level of 25(OH)D_(3) and the activity of ADAMTS13 in the good group were higher than those in the poor group,and the differences were statistically significant(P<0.05).ROC curve analysis showed that the area under the curve of PLA2R antibody,25(OH)D_(3) and ADAMTS13 for predicting renal function injury in patients with primary membranous nephropathy were 0.831,0.836 and 0.713 respectively.All of them were lower than 0.860 of combined detection of the three indicators to predict renal function injury in patients with primary membranous nephropathy(P<0.05).Conclusion Primary membranous nephropathy patients with peripheral blood PLA2R antibody levels will increase gradually with the patients with disease progressio n,and 25(OH)D_(3) level,ADAMTS13 activity will gradually decreased with aggravation,and the above three indicators combined detection has high predictive value for the above in the primary membranous nephropathy patients.