抗磷脂酶A2受体-IgG水平与乙型肝炎病毒相关膜性肾病关系  

Relationship between the level of antiphospholipid A2 receptor-IgG and hepatitis B virus-associated membranous nephropathy

作　　者：钟霞 潘建华[1] 童坚[2] ZHONG Xia;PAN Jianhua;TONG Jian(Department of Clinical Laboratory,Haikou People’s Hospital,Haikou 570208,China;Department of Surgery,Affiliated Hospital of Hainan Medical College,Haikou 570102,China)

机构地区：[1]海口市人民医院检验科,海口570208 [2]海南医学院附属医院外科

出　　处：《公共卫生与预防医学》2019年第4期90-93,共4页Journal of Public Health and Preventive Medicine

基　　金：国家“十三五”艾滋病和肝炎重大科技专项(2017ZX10202101-001-008)

摘　　要：目的调查M型磷脂酶A2受体(M-type phospholipase A2 receptor,PLA2R)在乙型肝炎病毒相关膜性肾病(Hepatitis B virus membranous nephropathy,HBV-MN)中的表达,并分析PLA2R表达与HBV-MN患者临床特征的相关性。方法 2016—2018年间69例活检证实为HBV-MN的患者以及206例健康志愿者被纳入该项回顾性研究。采用ELISA法测量血清PLA2R-IgG水平,免疫组织化学染色法检测肾小球沉积物中的PLA2R,评价PLA2R-IgG与PLA2R表达的相关性。比较血清PLA2R-IgG水平阳性和阴性HBV-MN患者之间的临床特征。结果健康志愿者血清抗PLA2R-IgG水平为0.09~ 0.81 mg/L 。选择PLA2R-IgG的截断值为0.81 mg/L,HBV-MN阳性率为68.11%。血清PLA2R-IgG与肾小球沉积物中PLA2R的表达一致性较好(Kappa系数=0.945, P =0.003)。在69例HBV-MN患者中,PLA2R-IgG阳性(>0.81 mg/L)患者的年龄(55.38±12.6 vs. 43.36±14.06, P =0.036)和24 h蛋白尿(8.16±1.55 vs. 3.03±1.60, P =0.003)显著高于PLA2R-IgG阴性(≤0.81 mg/L)患者,而血清白蛋白(21.27±6.24 vs. 26.93±6.49, P =0.026)显著低于血清PLA2R-IgG阴性患者。结论高滴度的PLA2R-IgG与HBV-MN患者预后不良相关。基于PLA2R-IgG定量分析可作为HBV-MN患者诊断和预后的可靠方法。Objective To investigate the expression of M-type phospholipase A2 receptor (PLA2R) in Hepatitis B virus membranous nephropathy (HBV-MN), and to analyze the correlation between the expression of PLA2R expression and clinical characteristics of patients with HBV-MN. Methods Sixty-nine patients with HBV-MN confirmed by biopsy and 206 healthy volunteers were included in the retrospective study over the period from 2016 to 2018. The level of PLA2R-LgG was measured by ELISA, and PLA2R in glomerular sediments was detected by immunohistochemical staining. The correlation between PLA2R-LgG and the expression of PLA2R was evaluated.The clinical characteristics of HBV-MN patients with positive and negative PLA2R-IgG in serum were compared according to the detection of serum antibodies. Results The level of PLA2R-LgG in serum of healthy volunteers ranged from 0.09-0.81 mg/L. The cutoff value of PLA2R-LgG was set at 0.81mg/L, and the positive rate of HBV-MN was 68.11%. Serum PLA2R-IgG was consistent with the expression of PLA2R in glomerular sediments (Kappa coefficient=0.945, P =0.003). In 69 patients with HBV-MN, the age (55.38±12.6 vs. 43.36±14.06, P =0.036) and 24-hour proteinuria (8.16±1.55 vs. 3.03±1.60, P =0.003) both were significantly higher in patients with positive PLA2R-LgG than those with negative PLA2R-LgG, while serum albumin level(21.27±6.24 vs. 26.93±6.49, P =0.026) was significantly lower than those patients with PLA2R-LgG negative. Conclusion High titers of PLA2R-LgG were associated with poor prognosis of patients with HBV-MN. Quantitative analysis based on PLA2R-LgG can be used as a reliable approach for the diagnosis and prognosis of patients with HBV-MN.

关 键 词：乙型肝炎病毒 膜性肾病 磷脂酶A2受体 临床特征 

分 类 号：R183.9[医药卫生—流行病学] R512.62[医药卫生—公共卫生与预防医学]