血清PLA2R抗体检测在特发性膜性肾病临床及治疗反应评价中的应用(附250例报告)  

Clinical application of serum PLA2R antibody detection in idiopathic membranous nephropathy

作　　者：李强[1,2] 张蓓茹[1] 何平[1] 秦晓松[3] 赵自霞[1] 张永哲[1] 王艳秋 孙广萍[1] LI Qiang;ZHANG Bei-ru;HE Ping;QIN Xiao-song;ZHAO Zi-xia;ZHANG Yong-zhe;WANG Yan-qiu;SUN Guang-ping(Department of Nephrology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院肾内科,辽宁沈阳110004 [2]抚顺矿务局总医院肾内科 [3]中国医科大学附属盛京医院检验科,辽宁沈阳110004

出　　处：《中国实用内科杂志》2018年第12期1173-1176,共4页Chinese Journal of Practical Internal Medicine

基　　金：辽宁省博士科研启动基金(201501005)

摘　　要：目的分析特发性膜性肾病(idiopathic membranous nephropathy,IMN)M型磷脂酶A2受体(M—type phospholipase A2 receptor,PLA2R)抗体的可能临床作用。方法选取2014年1月至2017年12月中国医科大学附属盛京医院肾内科住院的250例患者,所有患者均经肾脏病理诊断为IMN,采用酶联免疫吸附法测定基线PLA2R抗体水平。根据PLA2R抗体水平进行分组,抗体滴度≤14 ng/L为抗体阴性组(73例),抗体滴度>14 ng/L为抗体阳性组(177例),分析两组基线时各项指标的差异。154例患者接受治疗且至少随访6个月,其中阴性组46例,阳性组108例,评估PLA2R抗体对IMN患者治疗反应的预测价值。结果抗体阴性组24 h尿蛋白定量较阳性组患者低、血白蛋白较阳性组高,差异具有统计学意义(P<0.05),但是两组肾功能比较差异无统计学意义(P>0.05)。阳性组尿红细胞计数较高,而高密度脂蛋白胆固醇较低(P<0.05)。总有效率阳性组较阴性组低,并且起效慢,差异具有统计学意义(P<0.05)。结论血清PLA2R抗体与IMN患者病情活动性具有相关性,且与治疗反应相关,其有助于判断患者病情和预测治疗反应。Objective To evaluate the possible clinical role of M-type phospholipase A2 receptor (PLA2R)antibodyin the idiopathic membranous nephropathy (IMN)patients.Methods 250 IMN patients in Nephrology Department of Shengjing Hospital affiliated to China Medical University from Jan 2014 to Dec 2017 were enrolled in the study. All the patients were diagnosed by renal biopsy as IMN and determined the level of PLA2R antibody by ELISA method as baseline value.According to the level of PLA2R antibody,73 patients with antibody titer less than 14 ng/L were as negative group,and 177 patients with antibody titer more than 14 ng/L were.as positive group.The differences of each index at baseline between the two groups were analyzed.In addition,154 patients of them were treated and followed up for at least 6 months,including 46 in the negative group and 108 in the positive group.The predictive value of therapeutic response of PLA2R antibody in IMN patients was evaluated.Results The urinary protein level in the antibody negative group was lower than that in the positive group,and the serum albumin level was higher than that in the positive group (P<0.05),but there was no difference in renal function between the two groups.In addition,the urinary erythrocyte count was higher and high density lipoprotein level was lower in the positive group (P<0.05).The total effective rate of the positive group was lower than that of the negative group,and the effect was slower (P<0.05).Conclusion The level of PLA2R antibody in serum is correlated with disease activity of IMN patients and the response to treatment,so it is helpful to judge the patient's condition and predict the response to treatment,and has certain clinical significance.

关 键 词：M型磷脂酶A2受体 特发性膜性肾病 预后 

分 类 号：R692.31[医药卫生—泌尿科学]