膜性肾病相关自身抗体检测的临床意义  

Clinical significance of autoantibody detection in membranous nephropathy

作　　者：李佳 邓榕 黄清水[1] Li Jia;Deng Rong;Huang Qingshui(Department of Laboratory Medicine,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院检验科,南昌330006

出　　处：《中华检验医学杂志》2024年第9期993-998,共6页Chinese Journal of Laboratory Medicine

摘　　要：膜性肾病(MN)是临床上表现为肾病综合征的主要病理类型之一,包括一组临床和病理相似的肾脏疾病,特征性的病理改变是肾小球毛细血管基底膜弥漫性增厚,肾小球毛细血管袢上皮侧可见大量排列紧密、规则的免疫复合物沉积,是导致成人肾病综合征的一个常见原因。MN起病比较隐匿,早诊断、早治疗意义重大,依据病因可分为特发性膜性肾病(IMN)和继发性膜性肾病(SMN)。多种自身抗体如抗M型磷脂酶A2受体(PLA2R)抗体、抗Ⅰ型血小板反应蛋白7A域(THSD7A)抗体等证实为IMN、SMN或其他肾小球疾病诊断、鉴别诊断、疾病活动及预后的重要依据。近年来,不断发现MN相关新的生物标志物,已陆续鉴定足细胞靶抗原如神经表皮生长因子样1蛋白、信号素3B、原钙黏蛋白7、丝氨酸蛋白酶HTRA1、外泌素1/外泌素2、神经细胞黏附分子1等与MN相关,并分别具有独特的生物学意义,尤其对于PLA2R和THSD7A阴性的MN疾病诊断以及疾病预测具有重要临床价值。本文主要对膜性肾病相关靶抗原及自身抗体检测的临床意义进行综述。Membranous nephropathy(MN)is an autoimmune disease in the kidney glomerulus and one of the leading causes of nephrotic syndrome.It can be characterized by the regular immune complexes deposited between the podocyte and the glomerular basement membrane,causing nephrotic syndrome in adults.Early diagnosis and treatment of MN are of great importance.MN can be divided into idiopathic membranous nephropathy(IMN)and secondary membranous nephropathy(SMN)according to its etiology.Anti-M-type phospholipase A2 receptor(PLA2R)antibodies,anti-platelet reaction-protein type 17A domain(THSD7A)antibodies have been used for MN diagnosis.Since THSD7A,many target antigens such as neural epidermal growth factor-like 1 protein(NELL1),semaphorin 3B(Sema3B),protocadherins7(PCDH7),serine protease HTRA1(HTRA1),exostosin 1/exostosin 2(EXT1/EXT2),and neural cell adhesion molecule1(NCAM1)have been identified as MN-related biomarkers.The newly identified antigens are of unique clinical values,especially for PLA2R and THSD7A negative MN diagnosis.

关 键 词：肾小球肾炎 膜性 靶抗原 自身抗体 疾病诊断 疾病预测 

分 类 号：R692[医药卫生—泌尿科学]