特发性膜性肾病中血清磷脂酶A2受体抗体的临床意义  

Detection of serum phospholipase A2 receptor antibodies and its clinical significance in patients with idiopathic membranous nephropathy

作　　者：韩丹诺 谌贻璞[1] 王艳艳[1] 董鸿瑞[1] 芮宏亮[1] 王国勤[1] 程虹[1] 

机构地区：[1]首都医科大学附属北京安贞医院肾内科,北京100029

出　　处：《中国实用内科杂志》2015年第4期351-354,共4页Chinese Journal of Practical Internal Medicine

摘　　要：目的观察特发性膜性肾病(IMN)患者治疗前、后血清抗磷脂酶A2受体(PLA2R)抗体变化及与病情的关系。方法以首都医科大学附属北京安贞医院肾内科2013年1月至2014年3月诊断为IMN的52例患者为研究对象,分别用免疫组化及免疫荧光法检测肾小球中PLA2R表达及Ig G亚类沉积,用间接免疫荧光及酶联免疫吸附法检测血清抗PLA2R抗体,并进行相关关系分析。结果治疗前肾小球PLA2R和血清抗体阳性者占96.2%,肾小球Ig G4沉积为主者占100%。治疗后完全缓解者血清抗PLA2R抗体全部转阴;部分缓解者一半以上转阴;未缓解者持续阳性。Spearman秩相关分析显示,治疗前抗体水平与尿蛋白及血清胆固醇呈正相关;治疗后与尿蛋白、血清胆固醇及血清三酰甘油呈正相关,与血清白蛋白呈负相关。多元线性回归分析显示,治疗前抗体水平与尿蛋白呈正相关,治疗后与尿蛋白呈正相关而与血清白蛋白负相关。结论 IMN患者的血清抗PLA2R抗体水平与尿蛋白等检验指标及疾病转归密切相关。Objective To investigate the relationship between serum phospholipase A2 receptor（PLA2R） antibodies and clinical and laboratory parameters in patients with idiopathic membranous nephropathy（IMN）. Methods Fifty-two patients with IMN were enrolled in this study. PLA2 R and the Ig G subclasses in glomeruli were detected by immunohistochemistry and immunofluorescence staining, respectively. Serum PLA2 R antibodies（PLA2R-Abs） were measured by both indirect immunofluorescence test and enzyme linked immunosorbent assay. Afterward, the correlation between serum PLA2R-Abs and clinical and laboratory parameters was analyzed. Results Before treatment, both PLA2 R in glomeruli and PLA2R-Abs in serum were found in 96.2% patients and predominant Ig G4 deposition in glomeruli was detected in 100% patients. After treatment, serum PLA2R-Abs became negative in all the patients with complete remission and in more than half of the patients with partial remission. However, it remained positive in all the non-remission patients. Spearman rank correlation analysis showed that serum PLA2R-Ab levels were positively correlated with proteinuria and serum cholesterol levels before treatment. After treatment, serum PLA2R-Ab levels were positively correlated with proteinuria, serum cholesterol levels and triglyceride levels, and negatively correlated with serum albumin levels. Multiple linear regression analysis showed that serum PLA2R-Ab levels were positively correlated with proteinuria before and after treatment, and negatively correlated with serum albumin levels after treatment. Conclusion Serum PLA2R-Ab levels in IMN patients are closely linked with clinical and laboratory parameters reflective of disease severity including proteinuria levels.

关 键 词：特发性膜性肾病 磷脂酶A2受体 抗体 蛋白尿 

分 类 号：R692[医药卫生—泌尿科学]