抗磷脂酶A2受体抗体在特发性膜性肾病诊疗中的意义  

The significance of anti-PLA2R antibody for the diagnosis and treatment of idiopathic membranous nephropathy

作　　者：张义德[1] 戴厚永[1] 袁莉[1] 曹英杰[1] 施岚[1] 陈晓岚[1] 

机构地区：[1]南通大学附属医院肾脏内科,江苏南通226001

出　　处：《国际泌尿系统杂志》2017年第6期896-899,共4页International Journal of Urology and Nephrology

基　　金：南通市2016年科技项目（MS22016027）

摘　　要：目的 观察特发性膜性肾病（idiopathic membranous nephropathy,IMN）患者中抗磷脂酶A2受体（PLA2R）抗体阳性率,分析其在IMN患者临床中的意义.方法 分析本院自2015年4月至2016年11月之间住院患者,肾活检病理诊断为IMN的肾病综合征患者36例为研究对象,强的松联合环孢素A治疗6个月,收集患者治疗前后的24 h尿蛋白定量（TUpro）、内生肌酐清除率（Ccr）以及和血浆白蛋白（Alb）资料,使用酶联免疫吸附法检测血清抗PLA2R抗体滴度,统计学分析临床数据的相关性.结果 36例IMN患者中有抗PLA2R抗体阳性者28例,占77.7％,抗体阳性的IMN与阴性的IMN两组间在年龄、性别、高血压病（HTN）、2型糖尿病（T2DM）差异无统计学意义（P＞0.05）.抗体阳性组治疗前后的尿蛋白定量（TUpro）、Alb水平分别与治疗前后的抗PLA2R抗体有显著相关性（P＜0.05）,与Ccr无相关性（P＞0.05）.抗体阳性组TUpro更高,Alb更低,均有显著差别（P＜0.05）,Ccr偏低,两组间差异无显著性（P＞0.05）;治疗后抗PLA2R抗体转阴12例,占42.8％,7例完全缓解者均转阴.抗体阴性组在治疗后4例完全缓解,占50％,高于阳性组,但无统计学差异（P＞0.05）.结论 血清抗PLA2R抗体是一种非创伤性检测手段,在IMN的诊断上有较高的特异性.对指导IMN的临床诊治和预后判断有重要的意义.Objective To observe the expression of serum anti-PLA2R antibody and analyze its clinical significance in patients with idiopathic membranous nephropathy （IMN）.Methods A total of 36 patients with nephrotic syndrome were diagnosed as IMN by renal biopsy in our hospital from April 2015 to November 2016,and enrolled in the study.All these patients were treated with prednisone and cyclosporine A for 6 months.Creatinine clearance rate （Ccr）,24-hour total proteinuria （TUpro） and plasma albumin（Alb） were collected before and after treatment.Serum anti-PLA2R antibody was also assayed by enzyme-linked immuno sorbent assay （ELISA） at the same time.All the data were prepared for statistical analysis.Results Among the 36 patients with IMN,positive serum anti-PLA2R antibody in 28（77.7%） cases were found,and there were no significant differences in age,gender,prevalence of hypertension and type 2 diabetes mellitus between anti-PLA2R antibody positive and negative groups （P 〉 0.05）.The initial and post-therapeutic values of anti-PLA2R antibody was significantly correlated with corresponding values of both TUpro and serum albumin levels,respectively（P 〈 0.05）,but were not correlated with Ccr（P 〉 0.05）.In comparison with anti-PLA2R antibody negative group,there were significantly higher TUpro and lower Alb levels in anti-PLA2R antibody positive group （P 〈 0.05）.Ccr was comparatively lower in anti-PLA2R anti-body positive group,but there was no significance（P 〉0.05）.Twelve patients got anti-PLA2R anti-body negative and 7 patients had complete remission in anti-PLA2R antibody positive group after treatment,all the 7 patients＆#39; anti-PLA2R antibody became negative.Fore out of eight patients without anti -PLA2R antibody entered into complete remission,accounted for 50%.The prevalence of remission in anti-PLA2R antibody negative group was higher than that in anti-PLA2R antibody positive one,but there was no statistic significance（P 〉 0.05）.Conclusions The serum anti-PLA2R

关 键 词：肾小球肾炎 膜性 受体 磷脂酶A2 

分 类 号：R692[医药卫生—泌尿科学]