M型磷脂酶A2受体及其抗体在乙肝病毒相关性膜性肾病中的临床意义  

Role of M-type phospholipase A2 receptor and its antibody in hepatitis B virus-associated membranous nephropathy

作　　者：许向青[1,2] 朱雪婧[1,2] 袁曙光[1,2] 姜文玲[1,2] 夏运成[1,2] 刘虹[1,2] 李军[1,2] 孙林[1,2] 彭佑铭[1,2] 刘伏友[1,2] 

机构地区：[1]中南大学湘雅二医院肾内科,长沙410011 [2]中南大学肾脏病研究所,长沙410011

出　　处：《中南大学学报（医学版）》2016年第10期1064-1068,共5页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81300600);中南大学自由探索计划(2012QNZT146)~~

摘　　要：目的:研究M型磷脂酶A2受体(phospholipase A2 receptor,PLA2R)在乙肝病毒相关性膜性肾病(hepatitis B virus-associated membranous nephropathy,HBV-MN)患者血液及肾组织中的表达情况,并探讨肾组织PLA2R阳性表达在乙型肝炎相关性肾小球肾炎(hepatitis B virus associated glomerulone nephritis,HBV-GN)患者中的临床和病理特点。方法:选取经肾活检确诊的49例HBV-MN患者。检测血清抗PLA2R抗体以及肾组织PLA2R的表达,将患者分为肾组织PLA2R表达阳性组和阴性组,比较两组间临床指标、病理改变、血抗PLA2R抗体表达水平的差异。结果:17例患者存在肾组织PLA2R阳性表达,其中10例患者血清抗PLA2R抗体阳性。肾组织阳性组较阴性组24 h尿蛋白水平升高,血白蛋白水平下降,血清Hbs Ag阳性比例更高(70.5%),肾组织Hbs Ag表达比例更高(71%)。结论:肾组织PLA2R以及血清抗PLA2R抗体在HBV-MN患者中有一定表达,其表达可能与HBV-MN患者血清以及肾组织中Hbs Ag沉积有关。肾组织PLA2R阳性患者肾小球慢性损伤可能相对更重。Objective： To examine levels of M-type phospholipase A2 receptor （PLA2R） and its antibody in the patients with hepatitis B virus-associated membranous nephropathy （HBV-MN）, and to explore the correlation of PLA2R with laboratory parameters and pathological characteristics. Methods： A total of 49 adult patients with biopsy-proved HBV-MN were enrolled in this study.Levels of anti-PLA2R antibody in serum and PLA2R in renal tissue were detected. Patients were assigned into two groups： a positive PLA2R grouP and a negative PLA2R group. Differences in laboratory parameters and pathological characteristics were compared between the two groups. Results： Of 49 patients with HBV-MN, 17 had positive PLA2R expression in renal tissues. In the positive PLA2R group, 10 patients were positive for serum anti-PLA2R antibody. Patients with positive PLA2R expression in renal tissues showed higher levels of 24 hour urinary protein [（4.6±3.9） g/d], serum HbsAg （70.5%） and renal HbsAg expression （71%）, while lower level of serum albumin [ （24.1±7.5） g/L] than those of the negative group. Conclusion： PLA2R is expressed in the renal tissues and serum anti-PLA2R antibody can be detected in some HBVoMN patients. Positive PLA2R expression in renal tissue might be related to HbsAg deposition in serum and renal tissues. Patients with positive PLA2R expression in renal tissue have more severe glomerular sclerosis.

关 键 词：乙肝病毒相关性膜性肾病 磷脂酶A2受体 M型磷脂酶A2受体抗体 

分 类 号：R512.62[医药卫生—内科学] R692[医药卫生—临床医学]