血清抗磷脂酶A2受体抗体在特发性膜性肾病诊断及疗效判断中的意义  

Significance of Serum Anti-phospholipase A2 Receptor Antibody in the Diagnosis and Effect Judgement of Idiopathic Membranous Nephropathy

作　　者：陆晓华[1,2,3] 罗红艳 高永财[1,2,3] 王慧 鄂静[1,2,3] 郑亚莉 LU Xiaohua;LUO Hongyan;GAO Yongcai;WANG Hui;E Jing;ZHENG Yali(People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;不详)

机构地区：[1]宁夏回族自治区人民医院,宁夏银川750002 [2]西北民族大学第一附属医院 [3]宁夏医科大学附属自治区人民医院

出　　处：《中外医学研究》2021年第32期87-90,共4页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：国家自然科学基金资助项目(NSFC81860136)(NSFC81460161);2018年宁夏回族自治区重点研发项目(2018BEG03053);宁夏回族自治区重点研发计划重大(重点)项目(2018BFG02010);宁夏回族自治区重点研发项目(2019BEG03017)。

摘　　要：目的:探讨血清抗磷脂酶A2受体抗体(抗PLA2R抗体)在特发性膜性肾病诊断及疗效判断中的应用价值。方法:选取宁夏回族自治区人民医院肾内科2016年1月-2020年6月住院经过肾穿刺活检明确诊断为特发性膜性肾病(IMN组)的患者50例,继发性膜性肾病(SMN组)患者50例,非膜性肾病(非膜性肾病组)患者50例。肾穿刺前通过酶联免疫吸附法(Elisa方法)检测所有患者血清抗PLA2R抗体的滴度。IMN组治疗6个月后再次检测血清抗PLA2R抗体的滴度,使用SPSS 18.0统计学软件进行分析。比较三组患者血清抗PLA2R抗体的阳性率及通过血清抗PLA2R抗体诊断IMN的特异度和灵敏度,评价血清抗PLA2R抗体诊断与肾穿刺活检的一致性,比较IMN组中不同治疗效果(缓解及未缓解)患者治疗前后血清抗PLA2R抗体的滴度水平。结果:IMN组和SMN组患者抗PLA2R抗体阳性率分别为94%和14%,两组比较差异有统计学意义(P<0.05);IMN组与非膜性肾病组患者抗PLA2R抗体阳性率分别为94%和8%,两组比较差异有统计学意义(P<0.05)。以肾穿刺活检作为IMN诊断的金标准,根据血清抗PLA2R抗体水平诊断IMN的特异度为89%,灵敏度为94%,两者诊断的一致性检验Kappa值为0.798(P<0.01);IMN组治疗6个月后,缓解患者血清抗PLA2R抗体滴度较治疗前有下降,差异有统计学意义(P<0.05),未缓解患者治疗前后血清抗PLA2R抗体滴度比较差异无统计学意义(P=0.075)。结论:血清抗PLA2R抗体可作为诊断IMN的特异性血清学标志物,且在治疗过程中,其水平的变化可作为IMN疗效判断的一项重要指标。Objective:To investigate the value of anti-phospholipase A2 receptor antibody(anti-PLA2R antibody)in the diagnosis and effect judgement of idiopathic membranous nephropathy.Method:From January 2016 to June 2020,a total of 50 patients with idiopathic membranous nephropathy(IMN group)and 50 patients with secondary membranous nephropathy(SMN group)and non-membranous nephropathy(non-membranous nephropathy group)were selected from the nephrology department of People’s Hospital of Ningxia Hui Autonomous Region.Serum anti-PLA2R antibody titers were measured in all patients by Elisa before renal biopsy.The titer of anti-PLA2R antibody in IMN group was measured again after 6 months of treatment,and SPSS 18.0 was used for statistical analysis.The positive rate of serum anti-PLA2R antibody and the specificity and sensitivity of diagnosing IMN by serum anti-PLA2R antibody were compared among the three groups,and the consistency between the diagnosis of serum anti-PLA2R antibody and renal biopsy were evaluated,and the titer level of serum anti-PLA2R antibody before and after treatment in patients with different treatment effects(remission and non-remission)in IMN group was compared.Result:The positive rates of anti-PLA2R antibody in IMN group and SMN group were 94%and 14%respectively,and the difference was statistically significant(P<0.05).The positive rates of anti-PLA2R antibody in IMN group and non-membranous nephropathy group were 94%and 8%respectively,and the difference between the two groups was statistically significant(P<0.05).Using renal biopsy as the gold standard for the diagnosis of IMN,according to the level of anti-PLA2R antibody in serum,the specificity and sensitivity of the diagnosis of IMN were 89%and 94%respectively,and the Kappa value of both diagnosis was 0.798(P<0.01).After 6 months of treatment in IMN group,the titer of anti-PLA2R antibody in the remission patients decreased compared with that before treatment,and the difference was statistically significant(P<0.05).There was no significant difference

关 键 词：特发性膜性肾病 血清抗磷脂酶A2受体抗体 诊断 肾穿刺活检 

分 类 号：R692[医药卫生—泌尿科学]