血清抗PLA_(2)R抗体和肾小球PLA_(2)R抗原对特发性膜性肾病的临床价值  

Clinical Value of Serum Anti-PLA_(2)R and Glomerular PLA_(2)R Antigen in Patients with Idiopathic Membranous Nephropathy

作　　者：周龙荣 徐恩君 王中新[1] 徐元宏[1] ZHOU Longrong;XU Enjun;WANG Zhongxin(Department of Clinical Laboratory,The First Affiliated Hospital of Anhui Medical University,Anhui 230022,China)

机构地区：[1]安徽医科大学第一附属医院检验科,合肥230022

出　　处：《医学研究杂志》2023年第9期178-182,共5页Journal of Medical Research

摘　　要：目的探讨血清抗磷脂酶A_(2)受体抗体(serum anti-phospholipase A_(2)receptor antibody,sPLA_(2)R-Ab)和肾小球磷脂酶A_(2)受体抗原(glomerular phospholipase A_(2)receptor antigen,gPLA_(2)R-Ag)对特发性膜性肾病(idiopathic membranous nephropathy,IMN)的临床价值。方法选取2019年1月~2021年10月安徽医科大学第一附属医院肾内科收治的118例IMN患者,根据sPLA_(2)R-Ab水平,分为阴性组(n=44),1∶10效价组(n=16),1∶32效价组(n=40)和1∶100效价组(n=18);根据gPLA_(2)R-Ag的沉积情况,分为阴性组(n=10)和阳性组(n=108)。采用Kappa分析sPLA_(2)R-Ab和gPLA_(2)R-Ag检测的一致性,单因素分析比较患者的临床资料,采用Spearman相关性分析评价sPLA_(2)R-Ab效价与血清白蛋白(serum albumin,Alb)和24h尿蛋白(urine protein,UP)之间的相关性;采用Kaplan-Meier生存分析曲线比较sPLA_(2)R-Ab水平与临床缓解率的关系。结果sPLA_(2)R-Ab和gPLA_(2)R-Ag一致性分析Kappa值为0.288(P均<0.05);sPLA_(2)R-Ab阴性组与1∶100效价组血Alb、24h UP比较,差异均有统计学意义(P均<0.05);Spearman相关性分析显示,sPLA_(2)R-Ab与Alb、24h UP的相关系数分别为-0.405、0.418(P均<0.05);68例IMN患者确诊后规律治疗并随访,收集6个月内随访资料,12例(17.65%)患者得到了完全缓解,23例(33.82%)达到部分缓解,其余33例(48.53%)未缓解,随访期间sPLA_(2)R-Ab水平越低,缓解率越高(P<0.05);gPLA_(2)R-Ag阴性组与阳性组的sPLA_(2)R-Ab阳性率比较,差异有统计学意义(P<0.05),而血Alb和24h UP比较,差异无统计学意义(P>0.05)。结论sPLA_(2)R-Ab和gPLA_(2)R-Ag对IMN具有重要的临床价值,有条件者应结合应用。Objective To investigate the clinical efficiency of serum anti-phospholipase A_(2)receptor antibody(sPLA_(2)R-Ab)and glomerular phospholipase A_(2)receptor antigen(gPLA_(2)R-Ag)in patients with idiopathic membranous nephropathy(IMN).Methods A total of 118 patients with IMN admitted to the Department of Nephrology,the First Affiliated Hospital of Anhui Medical University from January 2019 to October 2021 were selected.Patients were divided into four groups based on sPLA_(2)R-Ab levels:the negative group(n=44),the 1∶10 titer group(n=16),the 1∶32 titer group(n=40),and the 1∶100 titer group(n=18).Patients were also divided into two groups based on the deposition of gPLA_(2)R-Ag:the negative group(n=10)and the positive group(n=108).Kappa was used to analyze the consistency of sPLA_(2)R-Ab and gPLA_(2)R-Ag.Univariate analysis was used to compare the clinical data of all the patients.Spearman correlation was used to explore the correlation between sPLA_(2)R-Ab with serum albumin(Alb)and 24h urine protein(UP).Kaplan-Meier survival analysis curve was used to compare the relationship between sPLA_(2)R-Ab level and clinical response rate.Results The consistency analysis of sPLA_(2)R-Ab and gPLA_(2)R-Ag yielded a Kappa value of 0.288(P<0.05).There were significant differences in serum Alb and 24h UP between the sPLA_(2)R-Ab negative group and the 1∶100 titer group(P<0.05).The Spearman correlation analysis showed that the correlation coefficients of sPLA_(2)R-Ab with Alb and 24h UP were-0.405 and 0.418,respectively(all P<0.05).After diagnosis,68 patients with IMN were treated regularly and followed up,follow-up data were collected within 6months,12 patients(17.65%)achieved complete response,23 patients(33.82%)achieved partial response,and the remaining 33 patients(48.53%)did not response.The lower the sPLA_(2)R-Ab level during follow-up,the higher the response rate(P<0.05).There was significant difference in the positive rate of sPLA_(2)R-Ab between the gPLA_(2)R-Ag negative group and the positive group(P<0.05).Howeve

关 键 词：抗磷脂酶A _(2)受体抗体 磷脂酶A _(2)受体抗原 特发性膜性肾病 

分 类 号：R446[医药卫生—诊断学]