特发性膜性肾病肾组织磷酯酶A_2受体的检测及其临床意义  

Detection and the clinical significance of phospholipase A_2 receptor in idiopathic membranous nephropathy tissues

作　　者：刘红[1,2,3] 骆伟丽 龚劭敏[1,2,3] 丁小强[1,2,3] 

机构地区：[1]复旦大学附属中山医院肾内科,上海200032 [2]上海市肾病与透析研究所,上海200032 [3]上海市肾脏疾病与血液净化重点实验室,上海200032

出　　处：《复旦学报（医学版）》2015年第4期479-483,共5页Fudan University Journal of Medical Sciences

基　　金：国家科技支撑计划(2011BAI10B00);上海市科委科研计划项目(14DZ2260200)~~

摘　　要：目的探讨特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者肾组织磷酯酶A2受体(phospholipase A2receptor,PLA2R)的检测情况并分析其临床意义。方法回顾性分析101例经临床和肾脏病理确诊为IMN并随访1年以上的患者(在本单位肾活检前均未接受激素或免疫抑制剂治疗);13例临床和病理确诊为系统性红斑狼疮Ⅴ型、乙型肝炎、干燥综合征相关等继发性膜性肾病及20例非膜性肾病患者作为对照组。检测各组患者肾组织PLA2R及IgG分型的结果,并分析PLA2R阳性及阴性IMN患者治疗前后尿蛋白、肾功能的变化。结果 86.14%IMN患者肾组织PLA2R阳性,而继发性膜性肾病患者肾组织PLA2R阳性率仅为23.08%(vs.IMN组,P<0.001)。83.75%IMN患者肾组织PLA2R阳性伴IgG4中度以上阳性;继发性膜性肾病患者中,无一例肾组织PLA2R阳性同时伴IgG4中度以上阳性(vs.IMN组,P<0.01)。47例肾组织PLA2R阳性的IMN患者予激素或激素联合免疫抑制剂治疗,随访6个月以上,85.11%患者尿蛋白缓解,而9例肾组织PLA2R阴性的IMN患者尿蛋白缓解率只有30.0%(vs.IMN PLA2R阳性组,P<0.01)。结论 IMN患者肾组织PLA2R阳性率高。肾组织PLA2R阳性伴IgG4中度以上阳性是鉴别IMN和继发性膜性肾病的重要指标。激素或/和免疫抑制剂可以更有效地降低肾组织PLA2R阳性IMN患者的蛋白尿。肾组织PLA2R阳性可能可以作为预测激素或免疫抑制剂治疗有效与否的重要指标。Objective To explore the positive rate and clinical significance of phospholipase A2 receptor （PLA2R） in glomeruli of idiopathic membranous nephropathy （IMN） patients. Methods A retrospective study was taken. In the study group, 101 patients who were both clinically and pathologically proved as IMN （All patients received neither glucocorticoid nor immunosupprants before having renal biopsy in our center ） and followed up more than 1 year were included. In the controlgroup,13 patients who were clinically and pathologically proved as membranous nephropathy secondary to systemm lupus erythematosus （Class V ）, hepatitis virus B, Sjogren＇s syndrome etc. and 20 patients whose pathological results were other than membranous nephropathy were included. PLA2R and the IgG subclasses m glomeruli were detected. The reduction of proteinuna and renal function were analyzed in both PLA2R positive and PLA2R negative IMN patients. Results Positive PLA2R glomerular deposits were found in 86.14%IMN patients while it was only 23.08 %in patients with secondary membranous nephropathy （P〈0. 001）. PLA2 R positive combined with IgG4 staining no less than moderate in the glomeruli was found in 83.75 % patients in IMN group, which was found in none of the patients in secondary membranous nephropathy group （P〈 0.01）. In IMN group.in the at least 6 months＇ follow up after either glucocorticoid or glucocorticoid combined immunosupprants therapy, 85.11 % patients with glomerular PLA2R positive had remission in proteinuria while it was only 30. 0% in patients with glomerular PLA2R negative （P〈0. 01）. Conclusions The positive rate of PLA2 R in the glomeruli was more prevalent in IMN patients. PLA2R positive deposits combined with IgG4 staining no less than moderate was critical to discriminate between idiopathic and secondary membranous nephropathy. Glomeruli PLA2 R deposits may be served as a nominator for therapeutic evaluation in IMN.

关 键 词：磷酯酶A2受体 特发性膜性肾病 继发性膜性肾病 蛋白尿 

分 类 号：R692.3[医药卫生—泌尿科学]