血清aPLA_(2)Rab评估PLA2R相关膜性肾病患者病情和预后的价值  

The value of serum aPLA_(2)Rab in evaluating the severity and prognosis of patients with PLA2R⁃related membranous nephropathy

作　　者：杨静[1] 杨爱祥 沈蕾[1] 沙文刚[1] 徐德宇[1] 李建中[1] 卢国元[1] YANG Jing;YANG Aixiang;SHEN Lei;SHA Wengang;XU Deyu;LI Jianzhong;LU Guoyuan(Department of Nephrology,the First Affiliated Hospital of Soochow University,Suzhou 215000;Intensive Care Unit,Suzhou Hospital Affiliated to Nanjing Medical University(North District of Suzhou State Hospital),Suzhou 215008,China)

机构地区：[1]苏州大学附属第一医院肾内科,江苏苏州215000 [2]南京医科大学附属苏州医院(苏州市立医院北区)重症监护室,江苏苏州215008

出　　处：《南京医科大学学报（自然科学版）》2023年第5期714-719,共6页Journal of Nanjing Medical University(Natural Sciences)

基　　金：苏州市卫生健康委员会科技项目(LCZX202002)。

摘　　要：目的:在磷脂酶A_(2)受体(PLA_(2)R)相关膜性肾病患者中观察血清抗磷脂酶A_(2)受体抗体(aPLA_(2)Rab)滴度与肾脏疾病严重程度以及肾脏预后的关系。方法:纳入苏州大学附属第一医院肾内科经肾活检证实为PLA_(2)R相关膜性肾病,且随访时间≥1年的患者共计273例。观察终点为肾功能不全,定义为估计肾小球滤过率(eGFR)较基线下降40%。收集患者各项临床检测指标进行统计学分析。结果:血清aPLA_(2)Rab滴度<50 RU/mL组44例(低滴度组)、50~<150 RU/mL组142例(中滴度组)、≥150 RU/mL组87例(高滴度组)。血清aPLA_(2)Rab滴度与性别、血清肌酐、总胆固醇、尿NAG、尿RBP、肾小球C4沉积显著正相关,与血清白蛋白显著负相关。血清aPLA_(2)Rab滴度为肾功能不全的独立危险因素,aPLA_(2)Rab滴度预测肾功能不全的截点值为135.66 RU/mL。1、5和10年未达肾功能不全的肾脏生存率低滴度组均为100%;中滴度组分别为100%、87.0%和75.5%;高滴度组分别为95.4%、72.3%和72.3%;3组有显著差异。结论:PLA_(2)R相关膜性肾病患者血清中aPLA_(2)Rab滴度水平与肾脏疾病严重程度以及肾脏预后相关,为以免疫学缓解为治疗目标的新理念提供理论支持。Objective:To observe the relationship between serum aPLA_(2)Rabtiter and the severity of renal disease and renal prognosis in patients with PLA2R⁃related membranous nephropathy.Methods:A total of 237 patients with PLA2R⁃related membranous nephropathy confirmed by renal biopsy in the Department of Nephrology of the First Affiliated Hospital of Soochow University were included and were followed up for≥1 year.The end point was renal insufficiency,defined as a 40%decrease of eGFR from baseline.Clinical indicators of patients were collected for statistical analysis.Results:A total of 273 patients were included in the current study,of which serum aPLA_(2)Rabtiter<50 RU/mL group(low titer group)had 44 cases,50~<150 RU/mL group(medium titer group)142 cases and≥150 RU/mL group(high titer group)87 cases.Serum aPLA_(2)Rabtiters were significantly correlated with gender,baseline serum albumin,serum creatinine,total cholesterol,urinary NAG,urinary RBP,and glomerular C4 deposition.Multivariate Cox analysis showed that aPLA_(2)Rabtiter was still an independent risk factor for renal insufficiency after correction for clinicopathological parameters.The cutoff point of serum aPLA_(2)Rabtiters for predicting renal insufficiency was 135.66 RU/mL,with a sensitivity of 65.8%and a specificity of 63.8%.The renal survival rates without reaching renal insufficiency at 1,5 and 10 years were all 100%in the low titer group;100%,87.0%and 75.5%in the medium titer group;95.4%,72.3%and 72.3%in the high titer group,respectively;there was a significant difference among the three groups.Conclusion:The current study further confirmed that the serum aPLA_(2)Rabtiter level in patients with PLA2R⁃related membranous nephropathy was related to disease severity and renal prognosis,providing theoretical support for the new concept of immunological remission as the therapeutic target.

关 键 词：膜性肾病 磷脂酶A_(2)受体 预后 危险因素 

分 类 号：R586[医药卫生—内分泌]