血清学PLA2R抗体和THSD7A抗体检测辅助诊断特发性膜性肾病及对评估疗效和预后的价值研究

Value of Serum PLA2R Antibody and THSD7A Antibody in Efficacy Assessment and Prognosis of Idiopathic Membranous Nephropathy

目的探讨血清学M型磷脂酶A2受体(PLA2R)抗体和1型血小板反应蛋白7A域(THSD7A)抗体检测辅助诊断特发性膜性肾病(IMN)及对评估疗效和预后的价值。方法选取2016年5月—2017年5月本院收治的146例IMN患者作为研究对象,根据酶联免疫吸附法检测结果将其分为PLA2R抗体阳性组120例和PLA2R抗体阴性组26例,THSD7A抗体阳性组11例和THSD7A抗体阴性组135例,均单用他克莫司免疫抑制治疗,比较临床资料与指标、治疗缓解率;同时采用多因素logistic回归分析影响IMN预后不良的独立危险因素和采用受试者工作特征(ROC)曲线分析血清PLA2R抗体、THSD7A抗体诊断IMN的价值。结果 (1)血清PLA2R抗体阳性组和阴性组性别、血清白蛋白、肾小管间质损害程度、尿α1-微球蛋白、尿β2-微球蛋白、尿免疫球蛋白G、尿N-乙酰-β-D-葡萄糖苷酶、发生终点事件比较差异具有统计学意义(P<0.05)。(2)血清THSD7A抗体阳性组和阴性组年龄、血清白蛋白、肾小管间质损害程度、尿α1-微球蛋白、尿β2-微球蛋白、尿免疫球蛋白G、尿N-乙酰-β-D-葡萄糖苷酶、发生终点事件比较差异具有统计学意义(P<0.05)。(3)多因素logistic回归分析显示:年龄≥60岁、肾小管间质损害≥25%、尿β2-微球蛋白≥1.17 mg/L、尿免疫球蛋白G≥24.98 mg/L、血清PLA2R抗体阳性和血清THSD7A抗体阳性均是影响IMN患者预后不良的独立危险因素(P<0.05);血清白蛋白≥25 g/L是IMN患者预后的保护因素(P<0.05)。(4)血清PLA2R抗体阳性组治疗缓解率(66.67%)明显低于血清PLA2R抗体阴性组(100.00%)(P<0.05);血清THSD7A抗体阳性组治疗缓解率(81.82%)明显低于血清THSD7A抗体阴性组(100.00%)(P<0.05)。(5)ROC曲线结果提示:血清PLA2R抗体、PLA2R抗体诊断IMN的灵敏度分别为88.35%、2.35%,特异度为66.68%、100.00%。结论血清学PLA2R抗体和THSD7A抗体检测对于IMN患者的诊断、疗效评估和预后方面均具有一定的临床价值,应大力推广。

Objective To investigate the value of serum M-type phospholipase A2 receptor(PLA2R)antibody and thrombospondin type-1 domain-containing 7 A(THSD7 A)antibody in efficacy assessment and prognosis of idiopathic membranous nephropathy(IMN).Methods The clinical data of one hundred and forty-six IMN patients who were admitted to Hubei Medical College Affiliated to Dongfeng Hospital from May 2016 to May2017 were retrospectively analyzed.According to the result of enzyme-linked immunosorbent assay,patients were divided into PLA2R antibody positive group(120 cases),PLA2R antibody negative group(26 cases),THSD7 A antibody positive group(11 cases)and THSD7 A antibody negative group(135 cases).All patients received the tacrolimus immunosuppressive therapy.The clinical data and indicators were compared;at the same time,multivariate logistic regression was used to analyze the independent risk factors affecting the prognosis of IMN.The value of serum PLA2R antibody and THSD7 A antibody in the diagnosis of IMN were analyzed using the receiver operating characteristic(ROC)curve.Results(1)The gender,serum albumin,tubulointerstitial damage degree,urineα1-microglobulin,urinaryβ2-microglobulin,urine immunoglobulin G,urine N-acetyl-β-D-glucosidase and end-point events of the PLA2R antibody positive group and negative group had significant difference(P<0.05);(2)The age,serum albumin,tubulointerstitial damage degree,urineα1-microglobulin,urinaryβ2-microglobulin,urine immunoglobulin G,urine N-acetyl-β-D-glucosidase and end-point events of the THSD7 A antibody positive group and negative group had significant difference(P<0.05);(3)Multivariate logistic regression analysis showed that age≥60 years,renal tubulointerstitial damage≥25%,urineβ2-microglobulin≥1.17 mg/L,urine immunoglobulin G≥24.98 mg/L,positive serum PLA2R antibody,positive serum THSD7 A antibody were independent risk factors that affected the prognosis of IMN patients(P<0.05);Serum albumin≥25 g/L was a protective factor for the prognosis of IMN patients(P<0.05);(4)The response rate of serum PLA2R antibody positive group was significantly lower than that of serum PLA2R antibody negative group(66.67%vs.100.00%,P<0.05);The response rate of serum THSD7 A antibody positive group was significantly lower than that of serum THSD7 A antibody negative group(81.82%vs.100.00%,P<0.05);(5)ROC curve results showed that the sensitivity of serum PLA2R antibody and PLA2R antibody in diagnosis of IMN was 88.35%and 2.35%,and the specificity was 66.68%and 100.00%.Conclusion Serum PLA2R antibody and THSD7 A antibody have certain clinical value in the diagnosis,therapeutic evaluation and prognosis of IMN patients,which is worthy of promotion.