特发性膜性肾病患者血清抗M型磷脂酶A_(2)受体抗体阳性率与肾间质损伤的关系  

Correlation between the positive rate of serum anti-M type phospholipase A_(2) receptor antibody and renal interstitial damage in patients with idiopathic membranous nephropathy

作　　者：王佳[1] 桑晓红[1] 张菁菁[1] WANG Jia;SANG Xiao-hong;ZHANG Jing-jing(Department of Nephrology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 830054,China)

机构地区：[1]新疆医科大学第一附属医院肾病科,新疆维吾尔自治区乌鲁木齐830054

出　　处：《中华实用诊断与治疗杂志》2021年第3期247-250,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：新疆维吾尔自治区自然科学基金(2016D01C319)。

摘　　要：目的观察特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者血清抗M型磷脂酶A_(2)受体(phospholipase A_(2)receptor,PLA_(2)R)抗体阳性率变化,探讨其对IMN患者发生肾间质损伤的预测价值。方法268例IMN患者,发生肾间质损伤219例为损伤组,未发生肾间质损伤49例为未损伤组。比较2组一般资料及24h尿蛋白定量、血肌酐、血尿酸、估算肾小球滤过率、血清白蛋白水平等;比较2组血清抗M型PLA_(2)R抗体阳性率;多因素logistic回归分析IMN患者发生肾间质损伤的影响因素;绘制ROC曲线,评估血清抗M型PLA_(2)R抗体阳性联合血肌酐、血清白蛋白、24h尿蛋白定量预测IMN患者发生肾间质损伤的价值。结果损伤组年龄[(46.32±13.20)岁]大于未损伤组[(35.16±9.53)岁](P<0.05),24h尿蛋白定量[(6.58±3.50)g]、血肌酐[(72.53±32.62)mmol/L]、血尿酸(352.26±96.48)mmol/L]水平均高于未损伤组[(4.04±1.78)g、(60.21±17.36)mmol/L、(309.05±72.64)mmol/L](P<0.05),估算肾小球滤过率[(92.83±18.71)mL/(min·1.73m^(2))]、血清白蛋白水平[(21.76±4.80)g/L]低于未损伤组[(122.03±32.05)mL/(min·1.73m^(2))、(28.91±6.18)g/L](P<0.05);2组性别比例、民族、体质量指数及血清三酰甘油、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平比较差异均无统计学意义(P>0.05)。损伤组血清抗M型PLA_(2)R抗体阳性(1∶10)率、血清抗M型PLA_(2)R抗体阳性(1∶100)率(49.8%、35.6%)均高于未损伤组(24.5%、12.2%)(P<0.05)。多因素logistic回归分析结果显示,24h尿蛋白定量(OR=1.503,95%CI:1.164~1.940,P=0.002)、血肌酐(OR=0.971,95%CI:0.944~1.000,P=0.047)、估算肾小球滤过率(OR=0.911,95%CI:0.867~0.958,P<0.001)、血尿酸(OR=1.011,95%CI:1.003~1.018,P=0.005)、血清白蛋白(OR=0.804,95%CI:0.720~0.898,P<0.001)、血清抗M型PLA_(2)R抗体(OR=19.939,95%CI:5.558~71.530,P<0.001)是IMN患者发生肾间质损伤的影响因素。ROC曲线分析结果显示,血清抗M型PLA_(2)R抗体阳�Objective To observe the changes of the positive rate of serum anti-M type phospholipase A_(2)receptor(PLA_(2)R)antibody in patients with idiopathic membranous nephropathy(IMN),and to explore the value of detection of the positive rate of anti-M type PLA_(2)R antibody to the prediction of renal interstitial damage in IMN patients.Methods Totally 268patients with IMN were divided into 219patients with renal interstitial damage(damage group)and 49 patients without renal interstitial damage(non-damage group).The general data,the levels of 24hurine protein quantification,serum creatinine,estimated glomerular filtration rate(eGFR)and serum albumin,and the positive rate of serum anti-M type PLA_(2)R antibody were compared between two groups.Multivariate logistic regression analysis was performed to evaluate the influencing factors of renal interstitial damage in IMN patients.ROC was drawn to assess the value of serum positive anti-M type PLA_(2)R antibody combined with serum creatinine,serum albumin and 24hprotein quantification to the prediction of renal interstitial damage in IMN patients.Results The patients were older in damage group((46.32±13.20)years)than non-damage group((35.16±9.53)years)(P<0.05).The levels of 24hurine protein quantification((6.58±3.50)g),serum creatinine((72.53±32.62)mmol/L)and blood uric acid((352.26±96.48)mmol/L)in damage group were higher than those in non-damage group(4.04±1.78)g,(60.21±17.36)mmol/L,(309.05±72.64)mmol/L)(P<0.05),the eGFR((92.83±18.71)mL/(min·1.73m^(2)))and serum albumin level((21.76±4.80)g/L)in damage group were lower than those in non-damage group((122.03±32.05)mL/(min·1.73m^(2)),(28.91±6.18)g/L)(P<0.05),and there were no significant differences in the sex ratio,ethnicity,body mass index,and the levels of serum triacylglycerol,total cholesterol,low-density lipoprotein cholesterol and high-density lipoprotein cholesterol between two groups(P>0.05).The positive(1∶10)rate and the positive(1∶100)rate of serum anti-M type PLA_(2)R antibody were higher in dama

关 键 词：特发性膜性肾病 肾间质损伤 血清抗M型磷脂酶A2受体抗体 24H尿蛋白定量 

分 类 号：R692[医药卫生—泌尿科学]