特发性膜性肾病应用糖皮质激素联合免疫抑制剂的疗效及与血清磷脂酶A2受体抗体水平相关性  

Correlation between serum anti-PLA2R antibody level and effectiveness of adrenocortical hormone combined with immunosuppressive agents for idiopathic membranous nephropathy

作　　者：董倩兰[1] 王琼[1] 张薇[1] 李振江[1] 张琳萍[1] Dong Qianlan;Wang Qiong;Zhang Wei;Li Zhenjiang;Zhang Linping(Nephrotic Hemodialysis Center, Shaanxi Provincial People′s Hospital, Xi′an 710068, China)

机构地区：[1]陕西省人民医院肾病血透中心,西安710068

出　　处：《山西医药杂志》2019年第4期406-409,共4页Shanxi Medical Journal

基　　金：陕西省社会发展科技攻关项目(2017SF-263)

摘　　要：目的探讨不同血清M型磷脂酶A2受体(PLA2R)抗体初始水平的特发性膜性肾病(IMN)患者应用糖皮质激素联合免疫抑制剂治疗的临床效果及相关性。方法将86例诊断为IMN的患者,依PLA2R抗体水平分为高浓度组和低浓度组,均给予糖皮质激素联合免疫抑制剂环磷酰胺治疗;分析2组患者临床治疗效果,干预前后尿蛋白定量(24 h)、血清白蛋白、血尿酸、血肌酐和血总胆固醇水平。结果低浓度组干预后临床治疗效果明显优于高浓度组,差异有统计学意义(P<0.05);干预前2组尿蛋白定量(24 h)、血清白蛋白、血尿酸、血肌酐和血总胆固醇水平差异无统计学意义,干预后各指标有所改善,低浓度组尿蛋白定量(24 h)下降水平和血清白蛋白上升水平明显优于高浓度组,差异有统计学意义(P<0.05);其他指标差异无统计意义(P>0.05)。结论应用糖皮质激素联合环磷酰胺治疗IMN,患者临床治疗效果与患者干预前血清PLA2R抗体水平呈负相关关系,临床可用于患者疾病缓解时间和预后的预测。Objective To investigate correlation between different serum type M phospholipase A2 receptor (PLA2R) antibody levels and the clinical effectiveness of adrenocortical hormone combined with immunosuppressive agents in patients with idiopathic membranous nephropathy (IMN). Methods A total of 86 patients who were diagnosed as IMN were included in this study. We divided the patients into high concentration group and low concentration group according to serum anti-PLA2R antibody levels, and both groups were treated with adrenocortical hormone in combination with immunosuppressant cyclophosphamide. The major efficacy outcomes index included 24-hour urinary protein, serum albumin, serum uric acid, serum creatinine and serum total cholesterol levels before and after intervention. Results There was no significant difference in the levels of urinary protein, serum albumin, serum uric acid, serum creatinine and serum total cholesterol between the two groups before intervention. The treatment effects in the low concentration group was better than that in the high concentration group (P<0.05). Compared with the high concentration group, patients in the low concentration group had a significant decrease in 24-hour urinary protein and an increase in 24-hour serum albumin(P<0.05);while no statistical significance was detected in other measurements(P>0.05). Conclusion In IMN patients who received glucocorticoid with cyclophosphamide, serum anti-PLA2R antibody level was negatively correlated with treatment effects when comparing with a high level. Therefore, serum anti-PLA2R antibody levels could be used to predict the remission duration and prognosis of IMN in clinical practice.

关 键 词：肾小球肾炎 膜性 糖皮质激素类 免疫抑制剂 

分 类 号：R692[医药卫生—泌尿科学]