适合中国人的抗磷脂酶A2受体抗体临界值的界定  

Definition of cut⁃off value of anti⁃phospholipase A2 receptor antibody suitable for Chinese patients

作　　者：蒋真斌 蔡美顺[1] 董葆[1] 燕宇[1] 王伊娜[1] 朱丽 李欣[1] 连立超[1] 王磊[1] 左力[1] Jiang Zhenbin;Cai Meishun;Dong Bao;Yan Yu;Wang Yina;Zhu Li;Li Xin;Lian Lichao;Wang Lei;Zuo Li(Department of Nephrology,People's Hospital,Peking University,Beijing 100044,China)

机构地区：[1]北京大学人民医院肾内科,北京100044

出　　处：《中华肾脏病杂志》2020年第5期379-384,共6页Chinese Journal of Nephrology

基　　金：国家自然科学基金(81870524)。

摘　　要：目的分析中国原发性膜性肾病(PMN)患者抗磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体水平,及其与临床指标的相关性,探讨更适合中国人的诊断临界值。方法入选2018年1月至2018年8月期间北京大学人民医院所有接受肾活组织检查者为研究对象,按照原发病分为原发性膜性肾病(PMN)组(包括特发性膜性肾病及原因未明的不典型膜性肾病患者)和对照组(除PMN以外的其他病理类型,包括继发性膜性肾病患者),回顾性收集和分析患者临床及病理资料。用酶联免疫吸附法(ELISA)检测入选者血抗PLA2R抗体水平,比较两组患者血抗PLA2R抗体水平的差异。采用Spearman相关分析法分析PMN患者血抗PLA2R抗体水平与临床指标的相关性;用Logistic回归模型法分析鉴别患者发生PMN的相关因素;用ROC曲线分析诊断PMN的优化临界值。结果共354例患者入选本研究,其中PMN组114例,对照组240例。PMN组年龄(51.7±14.1)岁,男/女比例为2.2∶1。PMN组患者血抗PLA2R抗体水平显著高于对照组[16.87(1.88,57.26)RU/ml比1.43(1.20,1.62)RU/ml,P<0.001]。PMN患者血抗PLA2R抗体水平与24 h尿蛋白量(r=0.278,P=0.003)、尿红细胞(r=0.190,P=0.043)呈正相关,与血白蛋白(r=-0.149,P=0.114)、血肌酐(r=0.136,P=0.149)无相关。ROC曲线分析结果显示,当设定抗PLA2R抗体的临界值为2.28 RU/ml时,鉴别PMN与其他病理类型的灵敏度为69.3%(95%CI 60.3%~77.0%),特异度92.9%(95%CI 89.0%~95.5%),曲线下面积0.859(95%CI 0.813~0.905,明显优于临界值为20.00 RU/ml(灵敏度46.5%,特异度97.5%)及14.00 RU/ml(灵敏度53.5%,特异度97.1%)。结论下调PMN主要致病抗体抗PLA2R抗体临界值至2.28 RU/ml,可提高鉴别诊断PMN与其他病理类型的灵敏度而不显著降低特异度。Objective To analyze the antibody level of phospholipase A2 receptor(PLA2R)in Chinese patients with primary membrane nephropathy(PMN)and its correlation with clinical indicators,and to explore more suitable cut⁃off value for Chinese patients.Methods All hospitalized patients with renal biopsy at Peking University People's Hospital from January to August 2018 were retrospectively reviewed.According to the primary disease,patients were divided into PMN group(including patients with idiopathic membranous nephropathy and atypical membranous nephropathy of unknown cause)and control group(other pathological types,including secondary membranous nephropathy patients).Their clinical and pathological characteristics were analyzed,and the level of serum PLA2R antibodies was detected using the method of enzyme⁃linked immunosorbent assay(ELISA).Spearman correlation was used to analyze the correlation between PMN patients'blood anti⁃PLA2R antibody level and clinical indicators.The risk factors of PMN were analyzed by logistic regression model,and the optimal cut⁃off value of PMN was analyzed by ROC curve.Results A total of 354 patients were included in this study,including 114 patients in PMN group and 240 patients in control group.The age of PMN group was(51.7±14.1)years old and the ratio of male to female was 2.2∶1.The median concentration of PLA2R antibody in PMN group was 16.87 RU/ml[inter⁃quartile range(IQR)1.88-57.26],which was significantly higher than that in control group(1.43 RU/ml,IQR 1.20-1.62,P<0.001).In PMN group,the concentration of anti⁃PLA2R antibody was correlated with the 24⁃hour urine protein ration(r=0.278,P=0.003)and urine erythrocyte(r=0.190,P=0.043),but not with serum albumin(r=-0.149,P=0.114)and serum creatinine(r=0.136,P=0.149).The ROC curve showed that the sensitivity of distinguishing PMN from other diseases was 69.3%(95%CI 60.3%-77.0%),the specificity was 92.9%(95%CI 89.0%-95.5%),and the area under the curve was 0.859(95%CI 0.813-0.905)when the cut⁃off value was set as 2.28 RU/ml

关 键 词：肾小球肾炎 膜性 受体 磷脂酶A2 诊断 鉴别 临界值 抗磷脂酶A2受体抗体 

分 类 号：R692[医药卫生—泌尿科学]