肾组织M-型磷脂酶A2受体抗原阳性的特发性膜性肾病患者临床特征分析  

Clinical features of patients with kidney tissue M-type phospholipase A2 receptor antigen positive idiopathic membranous nephropathy

作　　者：阎磊[1] 范晓光[1] 高素华[1] 顾玥[1] 朱清[1] 邵凤民[1] 

机构地区：[1]河南省人民医院郑州大学人民医院肾内科,河南郑州450003

出　　处：《新乡医学院学报》2017年第8期700-703,708,共5页Journal of Xinxiang Medical University

基　　金：河南省科技厅基础研究计划项目(编号:142300410075);河南省科技厅重点科技攻关计划项目(编号:112102310079)

摘　　要：目的检测特发性膜性肾病(IMN)患者肾组织M-型磷脂酶A2受体(PLA2R)抗原阳性率,分析其临床特征。方法回顾性分析2014年1月至2015年12月河南省人民医院肾内科肾活组织检查诊断为IMN患者87例,应用间接免疫荧光法检测肾组织PLA2R抗原,分析其阳性率。收集患者肾穿刺活检时的性别、年龄、血尿素氮、血肌酐、血清白蛋白、血脂、24 h尿蛋白定量等临床资料,分析IMN患者临床特征与病理的关系。结果在IMN患者87例中,81例(93.1%)肾组织PLA2R抗原阳性。81例PLA2R阳性患者中,男46例(56.8%),女35例(43.2%),男性居多。所有患者均存在不同程度的蛋白尿,表现为肾病综合征者49例(60.5%),合并高血压者28例(34.6%)。男性与女性相比,表现为肾病综合征者更常见,尿蛋白定量更大(P<0.05);肾组织PLA2R抗原阳性者与阴性者相比,两者在发病年龄、血红蛋白、血脂等因素上差异无统计学意义(P>0.05)。与<45岁组患者比较,≥45岁组患者低血清白蛋白、高胆固醇的临床表现更明显;随着24 h尿蛋白定量的增加,血清白蛋白下降,血红蛋白、血尿素氮、血肌酐、血总胆固醇水平升高(P<0.05)。结论 IMN患者肾组织中PLA2R抗原阳性率高,可作为IMN病理检测指标;肾组织PLA2R抗原阳性的IMN患者表现为肾病综合征者较为常见;男性、高龄及大量蛋白尿者,临床表现重。Objective To detect the positive rate of M-type phospholipase A2 receptor（PLA2R） antigen in renal tissue of idiopathic membranous nephropathy （IMN） patients,and analyze its clinical features.Methods The clinical features of 87 patients with IMN which was diagnosed by renal biopsy in the Department of Nephrology,Henan Provincial People＆#39;s Hospital from January 2014 to December 2015 were analysed retrospectively.The PLA2R antigen in kidney tissue was detected by indirect immunofluorescence method,and its positive rate was analysed.The clinical data （including sex,age,blood urea nitrogen,serum creatinine,serum albumin,blood fat,24-hour urinary protein etc.） of patients were collected.The relationship between clinical features and pathology was analyzed in IMN patients.Results In 87 IMN patients,the PLA2R antigen in renal tissue was was positive in 81 patients （93.1%）.Among the 81 patients with positive PLA2R antigen,there were 46（56.8%） males and 35 （43.2%） females,the number of male was more than female.All patients had varying degrees of proteinuria,49 （60.5%） patients were nephrotic syndrome,28（34.6%） patients were hypertension.Compared with female,nephrotic syndrome is more common and urine protein excretion was greater in male （P 〈 0.05）.There was no significant difference in the age,hemoglobin,blood fat between PLA2R antigen positive patients and negative patients （P 〉 0.05）.Compared with age 〈 45 years group,the clinical manifestation of hypoalbuminemia,hypercholesterolemia was more obvious in age ≥ 45 years group.With the increasing of 24-hour urinary protein excretion,the level of serum albumin was decreased,and the levels of hemoglobin,blood urea nitrogen,serum creatinine,total cholesterol were increased （P 〈 0.05）.Conclusion The positive rate of renal tissue PLA2R antigen is high in IMN patients,PLA2R antigen can be used as indicators of the pathological examination of IMN patients.Nephrotic syndrome is the major clinical manifestations in IMN pat

关 键 词：特发性膜性肾病 M-型磷脂酶A2受体 蛋白尿 肾病综合征 临床特征 

分 类 号：R692[医药卫生—泌尿科学]