血清抗M型磷脂酶A2受体抗体与特发性膜性肾病脾肾阳虚证的关联探讨  

Correlation of Serum Antibody to M-Type Phospholipase A2 Receptor and Syndrome of Spleen and Kidney Yang Deficiency in Patients with Idiopathic Membranous Nephropathy

作　　者：鲁欢[1] 涂海涛[1] 苏保林[1] 吴兴波[1] 王超[1] 罗月中[1] 

机构地区：[1]广州中医药大学第一附属医院,广东广州510405

出　　处：《辽宁中医杂志》2017年第5期905-909,共5页Liaoning Journal of Traditional Chinese Medicine

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(antibody to M-type phospholipase A2 receptor,anti-PLA2R)与特发性膜性肾病(idiopathic membranous nephropathy,IMN)脾肾阳虚证的关联。方法:选取2014年1月—2015年9月广州中医药大学第一附属医院肾病科住院患者,临床表现为肾病综合征(nephrotic syndrome,NS),经肾穿刺活检确诊的IMN患者40例,其中脾肾阳虚证31例,非脾肾阳虚证9例。采用酶联免疫吸附法检测患者血清anti-PLA2R,判断anti-PLA2R阴阳性。比较两组一般资料、实验室检查[血清白蛋白(ALB)、血清球蛋白(GLO)、血肌酐(Scr)、尿酸(UA)、甘油三酯(TG)、总胆固醇(CHOL)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、24 h尿蛋白总量(UTP)、尿红细胞计数(RBC(HPF))]、病理指标(系膜增生、新月体、肾小球硬化、肾小管萎缩/纤维化、肾间质炎症细胞浸润、肾间质血管病变及免疫荧光沉积);并对anti-PLA2R与两组差异有统计学意义指标分别行相关性分析。结果:脾肾阳虚组患者血清anti-PLA2R阳性率为70.97%,非脾肾阳虚组为33.33%,差异无统计学意义;脾肾阳虚组患者年龄、血清anti-PLA2R光密度、血清球蛋白水平均高于非脾肾阳虚组,差异均有统计学意义(P<0.05);病理指标方面,两组肾间质炎症细胞浸润构成比差异有统计学意义(P<0.05);脾肾阳虚组血清anti-PLA2R光密度与血清球蛋白呈正相关。结论:IMN脾肾阳虚证与血清anti-PLA2R存在一定的关联。Objective ：To evaluate the correlation of serum antibody to M -type phospholipase A2 receptor （anti -PLA2R） and syndrome of SPLEEN AND KIDNEY Yang deficiency in patients with idiopathic membranous nephropathy （IMN）. Methods： Forty patients with renal - biopsy proven IMN from January 2014 to September 2015 were enrolled. These patients were hospitalized for nephrotie syndrome （NS） in the Department of Nephrology in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. Among them, there were 31 patients with syndrome of spleen and kidney Yang deficiency and 9 patients with non - syndrome of spleen and kidney Yang deficiency. ELISA was used to detect serum antibody to PLA2R. Comparison was made between syndrome of spleen and kidney Yang deficiency group and non - syndrome of spleen and kidney Yang deficiency group in the general data,laboratory examination indexes （ ALB, GLO, Scr, UA, TG, CHOL, HDL - C, LDL - C, PT, AFFI＇, UTP and RBC （HPF） , pathological indexes （ mesangial proliferation, crescent formation, glomerulosclerosis, tubular atrophy/fibrosis, renal interstitial inflammatory cell infiltration, renal interstitial vascular disease and immunofluorescenee deposition ）. Correlation analysis was employed for the relationship between anti - PLA2R levels and indexes that had significant difference between two groups. Results：In syndrome of spleen and kidney Yang deficiency group, there were 22 patients with anti - PLA2R positive with a positive rate of 70.97%. In non -syndrome of spleen and kidney Yang deficiency group, there were 3 patients with anti -PLA2R positive with a positive rate of 33.33%. There was no significant difference in the positive rate of anti - PLA2R between these two groups. Patients in group of syndrome of spleen and kidney Yang deficiency were higher in age, the optical density of serum anti -PLA2R as well as GLO （P 〈 0. 05 ）. These two groups showed no significant difference in gender, course, MAP, UTP, ALB, Scr, UA, TG, CHOL, HDL -

关 键 词：特发性膜性肾病 M型磷脂酶A2受体 脾肾阳虚证 辨证 

分 类 号：R692[医药卫生—泌尿科学]