血清MBL、BAFF与磷脂酶A2受体相关特发性膜性肾病患者肾功能及疗效的关系  

Relationships between serum MBL,BAFF and renal function and outcome in patients with phospholipase A2 receptor-related idiopathic membranous nephropathy

作　　者：任海霞 刘菊红 李佳 申颖娇 李娟 REN Haixia;LIU Juhong;LI Jia;SHEN Yingjiao;LI Juan(Department of Nephrology,Changzhi People's Hospital,Changzhi 046000,China)

机构地区：[1]长治市人民医院肾内科,山西长治046000

出　　处：《山东医药》2024年第19期35-39,共5页Shandong Medical Journal

基　　金：山西省卫生计生委科研课题计划项目(2018156)。

摘　　要：目的探讨血清甘露聚糖结合凝集素(MBL)、肿瘤坏死因子家族B细胞活化因子(BAFF)与磷脂酶A2受体(PLA2R)相关特发性膜性肾病(IMN)患者肾功能和疗效的关系。方法选取PLA2R相关IMN患者103例作为观察组,并根据疗效将PLA2R相关IMN患者分为未缓解组(n=44)、缓解组(n=59);同期另选健康体检志愿者67例作为对照组。收集相关资料;用酶联免疫吸法检测血清MBL、BAFF、24 h尿蛋白,PA速率微板法试剂盒检测血肌酐,计算估计肾小球滤过率(eGFR)。Spearman相关法分析PLA2R相关IMN患者血清MBL、BAFF水平与肾功能指标的相关性;多因素Logistic回归分析影响PLA2R相关IMN患者疗效的因素,受试者工作特征(ROC)曲线分析血清MBL、BAFF对PLA2R相关IMN患者治疗未缓解的预测价值。结果观察组血清MBL、BAFF水平及24 h尿蛋白高于对照组,eGFR低于对照组(P均<0.05)。PLA2R相关IMN患者血清MBL、BAFF水平与eGFR呈负相关(r分别为-0.777、-0.760,P均<0.05),与24 h尿蛋白呈正相关(r分别为0.883、0.828,P均<0.05)。未缓解组白蛋白、eGFR低于缓解组,24 h尿蛋白、MBL、BAFF高于缓解组(P均<0.05),两组性别、年龄、血肌酐、血尿酸、血尿素氮、总胆固醇、甘油三酯、IgG、补体3和PLA2R抗体滴度比较差异无统计学意义(P均>0.05)。白蛋白和eGFR升高为PLA2R相关IMN患者疗效的独立保护因素(P均<0.05),24 h尿蛋白、MBL和BAFF升高为独立危险因素(P均<0.05)。ROC曲线分析结果显示,血清MBL、BAFF联合预测PLA2R相关IMN患者治疗未缓解的曲线下面积(0.880)大于二者单独预测(0.791、0.787),比较差异有统计学意义(Z分别为2.694、2.613,P均<0.05)。结论血清MBL、BAFF水平升高与PLA2R相关IMN患者肾功能降低及疗效差有关,二者联合检测预测PLA2R相关IMN患者治疗未缓解的价值较高。Objective To investigate the relationships between serum mannan-binding lectin(MBL),B-cell activating factor of the tumor necrosis factor family(BAFF)and renal function and outcome of patients with phospholipase A2 receptor(PLA2R)-related idiopathic membranous nephropathy(IMN).Methods Totally 103 patients with PLA2R-related IMN were selected as the observation group,and the patients with PLA2R-related IMN were divided into the non-remission group(n=44)and the remission group(n=59)according to the therapeutic efficacy;and another 67 cases of healthy physical examination volunteers were selected as the control group during the same period.Relevant data were collected;serum MBL,BAFF,and 24 h urine protein were detected by ELISA,blood creatinine was detected by PA rate microplate assay kit,and the estimated glomerular filtration rate(eGFR)was calculated.Spearman correlation method was used to analyze the correlation between serum MBL and BAFF levels and renal function indexes in patients with PLA2R-related IMN;multifactorial Logistic regression was used to analyze the factors affecting the efficacy of patients with PLA2R-related IMN,and the receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum MBL and BAFF for the unremitted treatment in patients with PLA2R-related IMN.Results Serum MBL,BAFF levels and 24 h urine protein were higher in the observation group than in the control group,and eGFR was lower than that in the control group(all P<0.05).Serum MBL and BAFF levels in patients with PLA2R-related IMN were negatively correlated with eGFR(r=-0.777,-0.760,respectively;all P<0.05)and were positively correlated with 24 h urinary protein(r=0.883,0.828,respectively;all P<0.05).Albumin and eGFR were lower in the non-remission group than in the remission group,and 24 h urinary protein,MBL and BAFF were higher than those in the remission group(all P<0.05).There were no statistically significant differences in the gender,age,blood creatinine,blood uric acid,blood urea nitrogen,total ch

关 键 词：磷脂酶A2受体相关特发性膜性肾病 甘露聚糖结合凝集素 肿瘤坏死因子家族B细胞活化因子 肾功能 疗效 

分 类 号：R692[医药卫生—泌尿科学]