sPLA2-ⅠB、PLA2R及PLA2R-AB在鉴别微小病变型肾病及特发性膜性肾病中的意义  

Role of sPLA2-ⅠB,PLA2R and PLA2R-antibody in Identification of MCD and IMN

作　　者：潘阳彬[1] 万建新[1] 陶璇[2] 邹臻寰[1] 徐卿 刘亚惠 杨丽燕 柯鸿婷 

机构地区：[1]福建医科大学附属第一医院肾内科,福州350005 [2]福建医科大学附属第一医院病理科,福州350005 [3]福建医科大学附属南平第一医院肾内科,南平353000

出　　处：《华中科技大学学报（医学版）》2017年第6期625-630,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.81670635);福建省自然科学基金资助项目(No.2016J01532);福建省卫生计生委中青年骨干人才培养项目(No.2016-ZQN-36)

摘　　要：目的检测分泌型磷脂酶A2-ⅠB(sPLA2-ⅠB)、M型磷脂酶A2受体(PLA2R)及抗M型磷脂酶A2受体抗体(PLA2R-AB)在微小病变型肾病(MCD)及特发性膜性肾病(IMN)中的表达,为临床上鉴别两类疾病寻找新的生物学检测指标。方法收集临床表现为肾病综合征并经肾穿刺病理检查证实为MCD(16例)及IMN(29例)患者的血清、尿液及肾脏病理标本。检测血清各项生化指标及尿蛋白定量,间接免疫荧光检测血清PLA2R-AB表达水平,免疫荧光检测肾小球PLA2R表达水平,ELISA检测血清sPLA2-ⅠB表达水平,免疫组化检测肾小球sPLA2-ⅠB表达水平。分析sPLA2-ⅠB、PLA2R及PLA2R-AB水平在MCD组及IMN组中的表达情况。结果 IMN组患者血清PLA2R-AB阳性率为69.0%,MCD组患者血清PLA2R-AB均为阴性(P<0.01)。IMN组肾小球足细胞PLA2R阳性率为86.2%,MCD组肾小球足细胞PLA2R阳性率为18.8%(P<0.01)。IMN组及MCD组血清sPLA2-ⅠB平均水平分别为(211.04±69.47)、(184.52±33.29)pg/mL(P>0.05)。IMN组和MCD组肾小球sPLA2-ⅠB的平均积分吸光度值分别为(1 849.90±506.07)、(1 143.63±323.68)(P<0.01)。结论 sPLA2-ⅠB、PLA2R及PLA2R-AB在MCD及IMN中表达有明显差异。联合检测sPLA2-ⅠB、PLA2R及PLA2R-AB有助于提高MCD及IMN的鉴别诊断水平。Objective To detect the levels of secretory phospholipase A2-ⅠB(sPLA2-ⅠB),M-type phospholipase A2 receptor(PLA2 R)and M-type phospholipase A2 receptor antibody(PLA2 R-AB)in minimal changed disease(MCD)and idiopathic membranous nephropathy(IMN)and try to find new biological parameters for identifying the two diseases.Methods Totally,45 renal disease patients diagnosed by renal biopsy were enrolled,consisting of 29 IMN and 16 MCD.Their clinical data of serum,urine and renal histopathological specimens were collected.Serum PLA2 R-AB was detected by indirect immunofluorescence assay.PLA2 Rin glomeruli was detected by direct immunofluorescence assay.Serum sPLA2-ⅠB was measured by ELISA.And sPLA2-ⅠB in glomeruli was determined by immunohistochemistry.Results The positive rate of serum PLA2 R-AB was 69.0%in 29 IMN patients,while it was 0.0%in 16 MCD patients(P<0.01).Similarly,the positive rate of PLA2 Rin glomeruli was86.2%in IMN patients,while it was 18.8%in MCD patients(P<0.01).Compared with the IMN patients,the MCD patients presented a significantly lower level of sPLA2-ⅠB IOD in glomeruli[(1 849.90±506.07)vs.(1 143.63±323.68),P<0.01].There was no difference in serum sPLA2-ⅠB level between the two groups[(211.04±69.47)pg/mL vs.(184.52±33.29)pg/mL,P>0.05].Conclusion There are significant differences in sPLA2-ⅠB,PLA2 Rand PLA2 R-AB between IMN patients and MCD patients.Joint detection of sPLA2-ⅠB,PLA2 Rand PLA2 R-AB can help to identify IMN and MCD.

关 键 词：膜性肾小球肾炎 微小病变型肾病 磷脂酶A2 鉴别诊断 

分 类 号：R692.31[医药卫生—泌尿科学]