PLA2R和THSD7A在特发性膜性肾病中的临床应用评价  

Evaluation on clinical application of PLA2R and THSD7A in idiopathic membranous nephropathy

作　　者：崔彩侠 高佩茹 徐鹏 吴雪平[1] 潘艳[1] 刘磊[1] 陈卫东 CUI Cai-xia;GAO Pei-ru;XU Peng;WU Xue-ping;PAN Yan;LIU Lei;CHEN Wei-dong(Department of Nephrology,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004;School of Graduate,Bengbu Medical College,Bengbu Anhui 233030,China)

机构地区：[1]蚌埠医学院第一附属医院肾内科,安徽蚌埠233004 [2]蚌埠医学院研究生院,安徽蚌埠233030

出　　处：《蚌埠医学院学报》2022年第9期1167-1171,共5页Journal of Bengbu Medical College

基　　金：安徽省重点研究与开发计划(202004j07020011)。

摘　　要：目的:探讨肾小球M型磷脂酶A2受体(PLA2R)和1型血小板反应蛋白7A域(THSD7A)及两者血清抗体水平检测在膜性肾病中的临床应用评价。方法:选取行肾活检确诊的原发性膜性肾病172例(IMN组),另选取同期确诊的继发性膜性肾病7例(SMN组)。应用免疫荧光法检测肾组织PLA2R和THSD7A抗原表达,ELISA方法检测病人血清PLA2R和THSD7A抗体水平。结果:IMN组中167例病人表现为单纯PLA2R阳性(97.1%),SMN组中有3例PLA2R阳性(42.9%),差异有统计学意义(P<0.01)。IMN组中有5例THSD7A阳性(2.9%),5例病人均合并PLA2R双阳(2.9%),SMN组0例THSD7A阳性,差异无统计学意义(P>0.05)。IMN组中143例病人血清PLA2R抗体阳性(83.1%),SMN组2例阳性(28.6%),差异有统计学意义(P<0.01)。2组病人血清中未检测出THSD7A抗体。2组病人性别、年龄、Alb、24hUpro、SCr、eGFR比较,差异均无统计学意义(P>0.05)。PLA2R-Ab与SCr、eGFR之间无相关关系(P>0.05),与Alb之间存在明显负相关关系(P<0.01),与24hUpro之间存在正相关关系(P<0.05)。PLA2R抗体阳性组Alb水平明显低于阴性组(P<0.01),PLA2R抗体阳性组24hUpro水平明显高于阴性组(P<0.05)。结论:PLA2R和THSD7A及其抗体检测有助于膜性肾病的诊断分型;PLA2R抗体水平可反映疾病活动度,可用于评估治疗效果;IMN病人THSD7A相关性膜性肾病的发病率较低。Objective:To evaluate the clinical application of glomerular M-type phospholipase A2 receptor(PLA2 R),thrombospondin type 1 domain-containing 7 A(THSD7 A)and their serum antibody levels in membranous nephropathy.Methods:A total of 172 cases of idiopathic membranous nephropathy(IMN)patients diagnosed by renal biopsy were selected as IMN group,and 7 cases of secondary membranous nephropathy(SMN)diagnosed in the same period were selected as SMN group.The expressions of PLA2 R and THSD7 A antigens in renal tissues were detected by immumofluorescence method,and the level of their serum PLA2 R and THSD7 A antibodies was measured by ELISA.Results:A total of 167 cases in the IMN group showed positive for PLA2 R alone(97.1%),and 3 cases in the SMN group were positive for PLA2 R(42.9%),which showed statistically significant difference(P<0.01).In the IMN group,5 cases were positive for THSD7 A(2.9%),and 5 cases showed positive for both PLA2 R and THSD7 A(2.9%);no THSD7 A-positive case was detected in the SMN group,and the difference had no statistical significance(P>0.05).In the test of serum PLA2 R,143 cases in the IMN group showed positive result(83.1%),2 cases in the SMN group were positive(28.6%),and the differences were statistically significant(P<0.01).No THSD7 A antibody was detected in the serum of the two groups.There were no statistically significant differences in sex,age,Alb,24 hUpro,SCr,and eGFR between the two groups(P>0.05).PLA2 R-Ab had no correlation with SCr and eGFR(P>0.05),but had a significant negative correlation with Alb(P<0.01),and a positive correlation with 24 hUpro(P<0.05).The Alb level in the PLA2 R antibody-positive group was significantly lower than that in the negative group(P<0.01),the 24 hUpro level in the PLA2 R-positive group was significantly higher than that in the negative group(P<0.05),and the differences were statistically significant.Conclusions:The detection of PLA2 R,THSD7 A and their antibodies can contribute to the diagnosis and classification of membranous nephropathy.The level

关 键 词：特发性膜性肾病 磷脂酶A2受体 1型血小板反应蛋白7A域 

分 类 号：R692[医药卫生—泌尿科学]