抗M型磷脂酶A2受体抗体水平对原发性膜性肾病患者临床特征及预后的影响  

Impact of anti-M-type phospholipase A2 receptorantibody levels on clinical features and prognosis ofindividuals with primary membranous nephropathy

作　　者：潘林林 包蓓艳 PAN Linlin;BAO Beiyan(Nephropathy Department,Ningbo Urology&Nephrology Hospital,Ningbo 315300,China)

机构地区：[1]宁波市泌尿肾病医院肾内科,浙江宁波315300

出　　处：《健康研究》2024年第1期90-94,共5页Health Research

基　　金：宁波市医学科技计划项目(2021Y51)。

摘　　要：目的 分析不同抗M型磷脂酶A2受体(phospholipase A2 receptor, PLA2R)抗体水平的原发性膜性肾病(primary membranous nephropathy, PMN)患者临床特征,比较其治疗效果及预后情况。方法 回顾性收集161例PMN患者的临床资料,根据血抗PLA2R抗体水平不同,将患者分为高效价组44例、低效价组57例、阴性组60例,比较三组患者临床特征、治疗反应及肾脏预后。Cox回归分析PMN患者临床缓解和不良预后的影响因素。结果 高效价组和低效价组患者中的男性占比、血尿比例、24 h尿蛋白量、D2聚体水平均高于阴性组,差异有统计学意义(均P<0.05)。高效价组患者合并肾病综合征的比例及舒张压、血肌酐、胆固醇、低密度脂蛋白水平均高于阴性组,血白蛋白、IgG水平低于阴性组,差异均有统计学意义(均P<0.05)。高效价组临床缓解率(70.5%)低于低效价组(87.7%)和阴性组(88.3%),差异有统计学意义(χ^(2)=7.088,P=0.029)。Cox回归分析显示,抗PLA2R抗体>150 RU/mL是PMN患者达到临床缓解的独立影响因素(HR=0.451,95%CI 0.288~0.706,P=0.001),肾病未缓解是PMN患者发生肾脏不良预后的独立影响因素(HR=17.922,95%CI 3.465~92.698,P=0.001)。结论 高抗PLA2R抗体水平的膜性肾病患者起病时病情往往更严重,且治疗反应不佳。Objective To compare and analyse the clinical features,therapeutic effects,and prognosis of primary membranous nephropathy(PMN)with different levels of anti-phospholipase A2 receptor antibodies.Methods Retrospectively collecting data from 161 PMN patients,this study classified patients into three groups based on their anti-phospholipase A2 receptor antibody levels:44 high titer,57 low titer,and 60 negative.The study then compared the clinical features,therapeutic effects,and prognosis of each group.Factors contributing to total remission and poor prognosis were analyzed using Cox regression.Results The study found that the proportion of males,hematuria,24-hour urine protein volume,and D2 polymer level were significantly higher in the high-efficiency price group and low-efficiency price group compared to the negative group(all P<0.05).The study found that the proportion of patients with combined nephrotic syndrome was higher in the high-efficiency price group than in the negative group.Additionally,the levels of diastolic blood pressure,blood creatinine,cholesterol,and low-density lipoprotein were also higher in the high-efficiency price group.Conversely,the levels of blood albumin and IgG were lower in the high-efficiency price group than in the negative group.All of these differences were statistically significant(P<0.05).The rate of clinical remission was statistically significantly lower in the high potency group(70.5%)compared to the low potency group(87.7%)and the negative group(88.3%)(χ^(2)=7.088,P=0.029).The Cox regression analysis revealed that anti-PLA2R antibody levels of>150 RU/mL were an independent factor influencing the attainment of clinical remission in PMN patients(HR=0.451,95%CI 0.288~0.706,P=0.001).Additionally,unremitting nephropathy was identified as an independent factor influencing the occurrence of poor renal prognosis in PMN patients(HR=17.922,95%CI 3.465~92.698,P=0.001).Conclusions Patients diagnosed with membranous nephropathy and high levels of anti-PLA2R antibodies are more likely to

关 键 词：原发性膜性肾病 抗M型磷脂酶A2受体抗体 治疗反应 预后 

分 类 号：R692[医药卫生—泌尿科学]