血清抗磷脂酶A2受体抗体与特发性膜性肾病患者临床病理及预后的关系  

Relationship of serum anti phospholipase A2 receptor antibody with clinicopathology and prognosis of idiopathic membranous nephropathy

作　　者：苏晨皓[1] 赵瑛瑛[1] 王建生[1] 张文吉[1] 张宛哲[1] 孟晶茜[1] 刘丁[1] 申鹏霄[1] 崔琴琴 Su Chenhao;Zhao Yingying;Wang Jiansheng;Zhang Wenji;Zhang Wanzhe;Meng Jingqian;Liu Ding;Shen Pengxiao;Cui Qinqin(Department of Nephrology and Rheumatology,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院肾病风湿免疫科,450014

出　　处：《中国实用医刊》2021年第1期14-18,共5页Chinese Journal of Practical Medicine

摘　　要：目的探讨血清抗磷脂酶A2受体(PLA2R)抗体与特发性膜性肾病(IMN)患者临床病理及预后的关系。方法抽取2017年1月至2020年1月在郑州大学第二附属医院经肾穿刺活检确诊的IMN患者92例,以抗PLA2R抗体血清检测结果为依据将其分为抗PLA2R抗体阴性组和抗PLA2R抗体阳性组。回顾性分析并比较两组患者的临床、病理资料及随访资料。结果 92例IMN患者中,抗PLA2R抗体阳性66例(抗PLA2R抗体阳性组),抗PLA2R抗体阴性26例(抗PLA2R抗体阴性组)。与抗PLA2R抗体阴性组比较,抗PLA2R抗体阳性组IMN患者有以下特点:①男性所占比例更高,年龄大,合并高血压及临床表现为肾病综合征者更多(P<0.05);②血沉更快,24 h尿蛋白定量更多,血白蛋白更低,肌酐、尿酸更高,肾小球滤过率估算值更低(P<0.05);③发生肾小球硬化的比例更高[45.5%(30/66)比15.4%(4/26)],P<0.05;④排除失访病例后,在随访6个月时达到完全缓解的比例更低[3.4%(2/58)比18.2%(4/22)],P<0.05。结论血清抗PLA2R抗体与IMN患者临床病理及预后关联密切,抗体阳性患者病情较重,完全缓解率较低。Objective To investigate the relationship of serum anti phospholipase A2 receptor(PLA2R)antibody with clinical features,pathological manifestations and outcomes of idiopathic membranous nephropathy(IMN).Methods A total of 92 patients with IMN definitely diagnosed by renal biopsy in the Second Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were enrolled in the study.And they were divided into two groups according to the serum anti-PLA2R antibody test results.The clinical,pathological and follow-up data of the two groups were collected and compared.Results Among 92 IMN patients,66 cases were positive for anti-PLA2R antibody(anti-PLA2R antibody positive group),and 26 cases were negative for anti-PLA2R antibody(anti-PLA2R antibody negative group).Compared with the serum anti-PLA2R antibody negative group,IMN patients in the anti-PLA2R antibody positive group had the following characteristics:①the higher proportion of male patients,elder average age of patients,more patients complicated with hypertension,and more patients with manifestation of nephrotic syndrome(P<0.05);②faster erythrocyte sedimentation rate,more 24 h urine protein,lower serum albumin level,higher creatinine and uric acid level,and lower estimated glomerular filtration rate(P<0.05);③higher incidence of glomerulosclerosis,45.5%(30/66)vs.15.4%(4/26),P<0.05;④lower rate of complete remission at 6 months after eliminating patients who lost to follow-up,3.4%(2/58)vs.18.2%(4/22),P<0.05.Conclusions Serum anti-PLA2R antibody is closely related to clinicopathology and prognosis of patients with IMN.And IMN patients with positive anti-PLA2R antibody have a more severe condition and a lower complete remission rate.

关 键 词：膜性肾病 抗磷脂酶A2受体抗体 病理 预后 

分 类 号：R692[医药卫生—泌尿科学]