血清抗磷脂酶A2受体抗体在特发性膜性肾病中的应用价值及与临床相关性探讨  

The value of serum anti-phospholipase A2 receptor antibody in idiopathic membranous nephropathy and its clinical relevance

作　　者：金娟[1] 任燕[1] 龚建光[1] 赵黎[1] 何强[1] JIN Juan;REN Yan;GONG Jian-guang;ZHAO Li;HE Qiang(Department of Nephrology,Zhejiang Provincial People's Hospital,Hangzhou,Zhejiang 310014,China)

机构地区：[1]浙江省人民医院杭州医学院附属人民医院肾脏病科,浙江杭州310014

出　　处：《中华全科医学》2020年第2期208-212,共5页Chinese Journal of General Practice

基　　金：浙江省科技计划项目(2014C03047-2);浙江省医药卫生科技计划项目(2016KYB007);浙江省中医药科学研究基金项目(2017ZA010)。

摘　　要：目的探讨血清抗磷脂酶A2受体抗体(serum anti-phospholipase A2 receptorantibod,抗PLA2R抗体)在特发性膜性肾病(idiopathic membranous nephropathy,IMN)中的应用价值,并探讨其滴度与IMN患者蛋白尿水平、估算的肾小球滤过率、肾功能、病理分期等临床指标的相关性。方法回顾性分析浙江省人民医院2014年1月-2018年10月经肾活检确诊并有血清抗PLA2R抗体检测结果的79例IMN患者的完整临床及实验室检测指标。结果 IMN患者抗PLA2R抗体阳性49例(62.0%);与抗PLA2R抗体阴性IMN相比,阳性患者总蛋白和白蛋白水平低;与低滴度抗PLA2R抗体组相比,高滴度组患者年纪更大,24 h尿蛋白量多,估算的肾小球滤过率、总蛋白和白蛋白水平低;与轻度尿蛋白组相比,重度组高滴度抗PLA2R抗体比率高,血清肌酐、总胆固醇和低密度脂蛋白高,估算的肾小球滤过率、总蛋白和白蛋白低;与青年IMN患者相比,中老年IMN患者女性比率高,血清高滴度抗PLA2R抗体比率高,尿素氮高估算的肾小球滤过率、总胆固醇和低密度脂蛋白水平低。血清抗PLA2R抗体滴度及其他实验室指标与病理分期无相关性。结论血清抗PLA2R抗体滴度与年龄、尿蛋白、肾功能、血清总胆固醇、低密度脂蛋白、血清总蛋白及白蛋白密切相关,在IMN诊断中具有较高的特异性,定量检测有助于临床病情判断。Objective To investigate the value of serum anti-phospholipase A2 receptor antibody(anti-PLA2 R antibody) in the diagnosis of idiopathic membranous nephropathy(IMN), and to explore the correlation between the its titer and clinical indexes such as the level of proteinuria, estimated glomerular filtration rate, renal function and pathological stage of IMN patients. Methods The clinical and laboratory data of 79 patients with IMN diagnosed by renal biopsy from January 2014 to October 2018 in our hospital with serum anti-PLA2 R antibody test results were retrospectively analyzed. Results There were 49 cases of anti PLA2 R antibody positive in IMN patients(62.0%). The levels of total protein and albumin in positive patients were lower than those in anti-PLA2 R antibody negative IMN. Compared with the low titer anti-PLA2 R antibody group, the patients in the high titer group were older, the 24-hour urinary protein was more, and the estimated glomerular filtration rate, total protein and albumin levels were lower. Compared with the mild urinary protein group, the severe group had higher anti-PLA2 R antibody ratio, higher serum creatinine, total cholesterol, low density lipoprotein, lower estimated glomerular filtration rate, total protein and albumin. Compared with young IMN patients, the middle-aged and elderly IMN patients had higher rates of female, high titers of anti-PLA2 R antibodies, urea nitrogen, estimated glomerular filtration rate, total cholesterol and low density lipoprotein levels.The titers of serum anti-PLA2 R antibody and other laboratory indexes were not correlated with pathological stages. Conclusion The titer of serum anti PLA2 R antibody is closely related to age, urinary protein, renal function, serum total cholesterol, low density lipoprotein, serum total protein and albumin, and has a high specificity in the diagnosis of IMN.

关 键 词：特发性膜性肾病 磷脂酶A2 酶联免疫吸附试验 

分 类 号：R692[医药卫生—泌尿科学] R446[医药卫生—外科学]