特发性膜性肾病患者血脂水平与PLA2R抗体和病理学表现的相关性及预后价值  

Correlation and prognostic value of blood lipid levels with PLA2R antibodies and pathological manifestations in patients with idiopathic membranous nephropathy

作　　者：夏璇 李晨[1] 申彬如 刘亚勤 付水鸽 XIA Xuan;LI Chen;SHEN Bin-ru;LIU Ya-qin;FU Shui-ge(Department of Nephrology,Rheumatology and Immunology,the First People's Hospital of Pingdingshan,Pingdingshan,Henan 467000,China)

机构地区：[1]平顶山市第一人民医院肾病风湿免疫科,河南平顶山467000

出　　处：《医药论坛杂志》2024年第14期1503-1507,1512,共6页Journal of Medical Forum

摘　　要：目的检测特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者血脂水平,分析其与抗磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体和病理学表现的相关性及预后价值。方法选取2020年4月至2023年4月平顶山市第一人民医院诊治的IMN患者124例,收集临床和病理资料。Spearman检验和logistic回归分析血脂水平和临床病理特征的关系,Cox回归评估血脂水平对治疗后蛋白尿缓解的预测能力。结果高密度脂蛋白胆固醇(HDL-C)降低和甘油三酯(TG)升高与肾小管萎缩相关,非高密度脂蛋白胆固醇(non-HDL-C)和TG降低与补体C1q沉积相关。TC(r=0.432,P<0.001)、non-HDL-C(r=0.462,P<0.001)、低密度脂蛋白胆固醇(LDL-C)(r=0.315,P<0.001)和TG(r=0.289,P<0.001)与蛋白尿正相关,HDL-C(r=-0.099,P=0.039)与蛋白尿负相关。TC(r=0.323,P<0.001)、non-HDL-C(r=0.396,P<0.001)和LDL-C(r=0.401,P<0.001)与血清抗PLA2R抗体滴度正相关,HDL-C(r=-0.057,P=0.539)和TG(r=0.110,P=0.229)与血清抗PLA2R抗体滴度无显著相关性。血清抗PLA2R抗体滴度(r=0.502,P<0.001)和肾小球LA2R沉积(r=6.381,P<0.001)与蛋白尿正相关。结论血脂异常与IMN患者病理表现存在相关性,高胆固醇血症是肾小球PLA2R沉积和血清抗PLA2R抗体阳性的独立危险因素,HDL-C、non-HDL-C和LDL-C是治疗后蛋白尿缓解的预测因素。Objective To analyze the correlation and prognostic value of serum lipid levels with anti phospholipase A2 receptor(PLA2R)antibodies and pathological manifestations in patients with idiopathic membranous nephropathy(IMN).Methods Totally 124 IMN patients diagnosed and treated in the First People's Hospital of Pingdingshan from April 2020 to April 2023 were selected,and clinical and pathological data were collected.Spearman test and logistic regression were used to analyze the relationship between blood lipid levels and clinicopathological characteristics,and Cox regression was used to evaluate the predictive ability of blood lipid levels on proteinuria remission after treatment.Results The reduction of high-density lipoprotein cholesterol(HDL-C)and the increase of triglycerides(TG)were associated with renal tubular atrophy,while the reduction of non-HDL-C and TG were associated with the deposition of complement C1q.Total cholesterol(TC)(r=0.432,P<0.001),non-HDL-C(r=0.462,P<0.001),low-density lipoprotein cholesterol(LDL-C)(r=0.315,P<0.001),and TG(r=0.289,P<0.001)were positively correlated with proteinuria,whereas HDL-C(r=-0.099,P=0.039)was negatively correlated with proteinuria.TC(r=0.323,P<0.001),non-HDL-C(r=0.396,P<0.001),and LDL-C(r=0.401,P<0.001)were positively correlated with the titer of serum anti-PLA2R antibodies,while HDL-C(r=-0.057,P=0.539)and TG(r=0.110,P=0.229)showed no significant correlation with the titer of serum anti-PLA2R antibodies.The titer of serum anti-PLA2R antibodies(r=0.502,P<0.001)and the deposition of PLA2R in renal glomeruli(r=6.381,P<0.001)were positively correlated with proteinuria.Conclusion There is a correlation between dyslipidemia and pathological manifestations of IMN patients.Hypercholesterolemia is an independent risk factor for glomerular PLA2R deposition and serum anti PLA2R antibody positive.HDL-C,non HDL-C and LDL-C are predictors of Proteinuria remission after treatment.

关 键 词：高脂血症 磷脂酶A2受体 膜性肾病 蛋白尿 高胆固醇血症 

分 类 号：R692[医药卫生—泌尿科学]