肾组织磷脂酶A2受体和血清抗磷脂酶A2受体抗体在膜性肾病中的诊断价值  

Diagnostic value of renal phospholipase A2 receptor and serum anti-phospholipase A2 receptor antibody in membranous nephropathy

作　　者：伍小香 文思[1] 朱雪婧[1] 袁曙光[1] 许向青[1] 杨淡昳[1] 孙林[1] 刘虹[1] 刘伏友[1] 

机构地区：[1]中南大学湘雅二医院肾内科,长沙410011

出　　处：《中南大学学报（医学版）》2017年第4期395-399,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:检测特发性膜性肾病(idiopathic membranous nephropathy,IMN)、继发性膜性肾病(secondary membranous nephropathy,SMN)患者肾组织中磷脂酶A2受体(phospholipase A2 receptor,PLA2R)的表达及血清抗PLA2R抗体滴度,分析其在诊断IMN中的价值。方法:2014年5月至2015年2月中南大学湘雅二医院肾内科肾活检患者73例,分为IMN组(n=48)、SMN组(n=17)和微小病变性肾病组(n=8)。采用间接免疫荧光法检测各组肾组织PLA2R及血清抗PLA2R抗体的表达。结果:IMN组肾组织PLA2R阳性率为91.7%,SMN组阳性率为29.4%,IMN组阳性率、荧光强度明显高于SMN组(均P<0.05);IMN组血清PLA2R抗体阳性率为85.4%,SMN组阳性率为29.4%,IMN组抗体阳性率及滴度明显高于SMN组(均P<0.05);微小病变性肾病组肾组织PLA2R抗原及血清抗体均呈阴性。IMN组血清PLA2R抗体滴度与24 h尿蛋白呈正相关(r=0.432,P<0.01),与血清白蛋白呈负相关(r=–0.307,P<0.05)。结论:检测肾组织PLA2R和血清PLA2R抗体的表达有助于IMN的诊断及鉴别诊断,监测血清PLA2R抗体滴度有助于评估疾病活跃程度和治疗效果。Objective： To examine the expression ofphospholipase A2 receptor （PLA2R） in renal tissues and the level of anti-PLA2R antibody in serum in patients with idiopathic membranous nephropathy （IMN） and secondary membranous nephropathy （SMN）, and to evaluate their diagnostic value in IMN.Methods： A total of 73 pat!ents, who were diagnosed between May3 2014 and February3 2015 in the Department of Nephrology of the Second Xiangya Hospital, Central South University3 were divided into three groups： an IMN group （n=48）, an SMN group （n=17） and a minimal change disease group （n=8） according to the renal biopsy. PLA2R expression in renal tissues and the level of anti- PLA2R antibody in serum were detected by indirect immunofluorescence technique. Results： The positive rate and fluorescence intensity for PLA2R in the renal tissues in the IMN group were higher than those in the SMN group （91.7% in the IMN group vs 29.4% in the SMN group, P〈0.05）, while the positive rate and serum level for anti-PLA2R antibody in the IMN group were higher than those in the SMN group （85.4% in the IMN group vs 29.4% in the SMN group, P〈0.05）; the expression of PLA2R in renal tissues and the serum level for anti-PLA2R antibody were not detected in the minimal change disease group, q-he serum level of anti-PLA2R antibody was positively correlated with 24 h urine protein （r=0.432, P〈0.01） and negatively correlated with serum albumin （r=-0.307, P〈0.05）. Conclusion： The expression of PLA2R in renal tissues and the serum level of anti-PLA2R antibody might be potential markers for diagnosis oflMN.

关 键 词：膜性肾病 M型磷脂酶A2受体 抗磷脂酶A2受体抗体 

分 类 号：R692[医药卫生—泌尿科学]