磷脂酶A2受体抗体在特发性膜性肾病中的诊断价值  

Diagnostic value of serum anti-phospholipase A2 receptor antibodies （PLA2R） in idiopathic membranous nephropathy

作　　者：牛广华[1] 高玉洁[1] 王柏山[1] 吴丽娜[2] 郭宏洋 崔百慧 张程[1] 郭鹤[1] 

机构地区：[1]辽宁中医药大学附属医院临床检验中心,沈阳110032 [2]中国医科大学附属盛京医院检验科

出　　处：《中华检验医学杂志》2015年第9期595-599,共5页Chinese Journal of Laboratory Medicine

基　　金：2014年辽宁省自然科学基金（2014020049）

摘　　要：目的：探讨抗磷脂酶A2受体（PLA2R）抗体在成人特发性膜性肾病（IMN）中的诊断作用和联合监测价值。方法回顾性研究，选择2013年1月至2014年6月期间辽宁中医药大学附属医院、中国医科大学附属盛京医院肾内科住院患者肾活检明确诊断的IMN患者48例，非特发性膜性肾病（ NIMN）患者115例（其中过敏性紫癜性肾病亚组23例，狼疮性肾病亚组39例，IgA肾病亚组24例，肿瘤相关肾病亚组29例）；选择辽宁中医药大学附属医院临床体检中心体检健康的志愿者35例作为对照组。采用间接免疫荧光法（IIF）检测各组患者血清中PLA2R抗体，并观察抗体荧光强度与IMN组病理分期及24小时尿蛋白（24 h PRO）、血尿素氮（UREA）、胱抑素C（CYSC）、血尿酸（URIC）、肾小球滤过率估算值（ eGFR）等进行相关性分析。组间比较采用t检验，χ^2做相关性分析。结果（1）48例IMN组血清标记的基质片中，37例标本PLA2R抗体基质荧光呈阳性，阳性率为77．08％；NIMN组中，基质胞浆荧光均为阴性。 IMN组患者血清PLA2R抗体的敏感度为77．08％，其特异度达100．00％。（2）与对照组比较，IMN组各肾功能主要相关指标均明显增高，差异有统计学意义（对照组与IMN组UREA分别为4．12±1．25、6．02±2．28， t＝4．446，P＝0．00；UA分别为262±49、331±112， t＝2．577，P＝0．017；CYSC分别为0．78±0．21、1．16±0．27， t＝4．63，P＝0．00）；NIMN组各亚组肾功能主要相关指标也存在差异有统计学意义（对照组与过敏性紫癜性肾病亚组UREA分别为4．12±1．25、5．43±1．84，t＝3．606，P＝0．0002；UA分别为262±49、299±51， t＝1．050，P＝0．03；CYSC分别为0．78±0．21、1．06±0．31， t＝1．672，P＝0．02。对照组与狼疮性肾病亚组UREA分别为4．12±1．25、5．90±2．20，t＝4．225，P＝0．00；UA分别为262±49、342±92，t＝2．409，P＝Objective To investigate the diagnostic value and monitoring application of anti-phospholipase A2 receptor antibodies （ PLA2R ） in patients with idiopathic membranous nephropathy （ IMN） .Methods A retrospective study was used .48 patients were diagnosed as idiopathic membranous nephropathy by puncturing kidney from January of 2013 to June of 2014 in the Hospital of Liaoning Traditional Chinese Medical University and Shengjing Hospital of China Medical University were included. 43 patients were diagnosed as non-idiopathic membranous nephropathy （ NIMN ）.35 healthy volunteers were selected as control groups.Serum PLA2R were detected by indirect immunofluorescence.The intensity of antibodies fluorescence and the level of urine protein in 24 hours（24 h PRO） ,serum UREA ,serum CYSC, serum UA,GFR were compared in each groups.Measurement data was shown as mean ±standard deviation;Count data was shown as frequency or composition, t test andχ^2 test were used as statistical method.Results （1） Among 48 cases with IMN,37 cases showed positive PLA2R （positive rate 77.08%）.All of cases were negative in NIMN group.The sensitivity and the specificity of serum PLA2R were 77.08%and 100%.（2） Compared with control groups, the levels of UREA, CYSC and UA were found statistically significant differences in patients with IMN （ P 〈0.05 ） .（ The levels of UREA in control groups and IMN groups respectively：4.12 ±1.25,6.02 ±2.28, t =4.446,P=0.00;UA：262 ±49,331 ±112,t =2.577,P =0.017;CYSC：0.78 ±0.21,1.16 ±0.27,t=4.63,P=0.00.） Compared with control groups, the levels of main items in patients with NIMN had statistically significant differences （P〈0.05）.（The levels of UREA in control groups and Allergic purpura nephropathy subgroups respectively：4.12 ±1.25,5.43 ±1.84,t=3.606,P=0.000 2;UA：262 ±49, 299 ±51, t=1.050,P=0.03;CYSC：0.78 ±0.21, 1.06 ±0.31, t=1.672,P=0.02.The levels of UREA in control groups and lupus nephropathy subgroups respectively：4.12 ±1.25, 5.90 ±2.20,

关 键 词：受体 磷脂酶A2 肾小球肾炎 膜性 自身抗体 荧光抗体技术 间接 

分 类 号：R692[医药卫生—泌尿科学]