血清抗M型磷脂酶A2受体抗体对成年人特发性膜性肾病诊治的指导作用  

Role of M- type Phospholipase A2 Receptor Antibody in the Diagnosis and Treatment of Idiopathic Membranous Nephropathy in Adults

作　　者：鲁欢[1] 汤水福[2] 陈刚毅[2] 苏保林[2] 吴兴波[2] 王超[2] 涂海涛[2] 罗月中[2] 

机构地区：[1]广州中医药大学,广东省广州市510405 [2]广州中医药大学第一附属医院肾病科

出　　处：《中国全科医学》2016年第14期1647-1652,共6页Chinese General Practice

基　　金：国家自然科学基金资助项目(81373568)

摘　　要：目的探讨血清抗M型磷脂酶A2受体抗体(anti-PLA2R)对成年人特发性膜性肾病(IMN)诊治的指导作用。方法选取2014年1月—2015年5月广州中医药大学第一附属医院经肾穿刺活检确诊的肾小球疾病患者58例,其中IMN者31例(IMN组),非IMN者27例(非IMN组)。采用酶联免疫吸附试验(ELISA)法检测患者血清anti-PLA2R,判断anti-PLA2R阴阳性。比较IMN组和非IMN组、IMN患者中anti-PLA2R阳性者和阴性者一般资料、实验室检查指标〔24 h尿蛋白总量(UTP)、血清清蛋白(Alb)、血肌酐(Scr)、尿红细胞计数(RBC)(HPF)、尿酸(UA)、血浆凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)〕、病理指标(系膜增生、新月体、肾小球硬化、肾小管萎缩/纤维化、肾间质炎性细胞浸润、肾间质血管病变及免疫荧光沉积)和治疗效果。结果 IMN患者中血清anti-PLA2R阳性者21例,阳性率为67.7%;非IMN患者中血清anti-PLA2R阳性者1例,阳性率为3.7%。IMN组年龄、血清anti-PLA2R光密度高于非IMN组,尿RBC(HPF)、PT、INR、APTT低于非IMN组(P<0.05);两组性别、平均动脉压(MAP)、UTP、Alb、Scr、UA、FIB比较,差异均无统计学意义(P>0.05)。血清anti-PLA2R阳性者anti-PLA2R光密度高于阴性者(P<0.05);两组性别、年龄、病程、MAP、UTP、Alb、Scr比较,差异均无统计学意义(P>0.05)。Spearman相关分析结果显示,血清anti-PLA2R光密度与MAP、UTP、Alb、Scr无相关关系(r_s=0.097、-0.208、0.266、-0.358,P>0.05)。血清anti-PLA2R阳性者和阴性者系膜增生、新月体、肾小球硬化、肾小管萎缩/纤维化、肾间质炎性细胞浸润、肾间质血管病变及免疫荧光Ig A、C_3阳性率比较,差异均无统计学意义(P>0.05)。血清anti-PLA2R阳性者中5例(23.8%)患者接受免疫抑制剂治疗,血清anti-PLA2R阴性者中5例(50.0%)患者接受免疫抑制剂治疗,两组患者接受免疫抑制治疗率比较,差异无统计学意义(P=0.2Objective To evaluate the role of M- type phospholipase A2 receptor antibody（ anti-PLA2R） in the diagnosis and treatment of idiopathic membranous nephropathy（ IMN） in adults. Methods From January 2014 to May 2015,we enrolled 58 patients who were definitely diagnosed with glomerular disease by renal biopsy in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. Among them,there were 31 IMN patients（ IMN group） and 27 non- IMN patients（ non- IMN group）. ELISA method was used to detect serum anti-PLA2 R,in order to determine anti-PLA2 R was positive or negative. Comparison was made between IMN group and non- IMN group in the general data,laboratory examination indexes 〔24h UTP,Alb,Scr, urine RBC（ HPF）, UA, PT, INR, APTT and FIB 〕, pathological indexes（ mesangial proliferation,crescent formation,glomerulosclerosis,tubular atrophy / fibrosis,renal interstitial inflammatory cell infiltration,renal interstitial vascular disease and immunofluorescence deposition） and clinical outcomes and the same comparison was made between anti-PLA2 R positive and anti-PLA2 R negative. Results In IMN group,there were 21 patients with anti-PLA2 R positive with a positive rate of 67. 7%. In non- IMN group,there was one patient with anti-PLA2 R positive with a positive rate of 3. 7%. IMN group was higher in age,the optical density of serum anti-PLA2 R and lower in urine RBC（ HPF）,PT,INR and APTT than non- IMN group（ P〈 0. 05）. The two groups were not significantly different in gender,MAP,UTP,Alb,Scr,UA and FIB（ P〈 0. 05）. Patients with serum anti-PLA2 R positive were higher than patients with anti-PLA2 R negative in the optical density of serum anti-PLA2R（ P〈 0. 05）. The two groups were not significantly different in gender,age,length of disease,MAP,UTP,Alb and Scr（ P〈 0. 05）. Spearman correlation analysis showed that the optical density of serum anti-PLA2 R had no correlation with MAP,UTP,Alb and Scr（ r_s= 0. 097,- 0. 208,0. 266,- 0. 358; P〈 0. 05）. Patie

关 键 词：肾小球肾炎 膜性 抗M型磷脂酶A2受体抗体 治疗 

分 类 号：R692.31[医药卫生—泌尿科学]