血清IgG/C3水平对磷脂酶A2受体抗体阴性的糖尿病伴蛋白尿患者膜性肾病的预测价值  

Predictive value of serum IgG/C3 levels for membranous nephropathy in diabetics with proteinuria and negative phospholipase A2 receptor antibody

作　　者：王欢 山晓微 张德伟 Wang Huan;Shan Xiao-wei;Zhang De-wei(Department of Nephrology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院肾脏病科,沈阳110016

出　　处：《临床肾脏病杂志》2024年第12期977-982,共6页Journal Of Clinical Nephrology

基　　金：辽宁省应用基础研究计划项目(2022JH2/101500042)。

摘　　要：目的检测血清M型磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体阴性且表现为单纯蛋白尿的糖尿病患者血清免疫球蛋白(immunoglobulin,Ig)G/C3水平,探索其对糖尿病合并膜性肾病(membranous nephropathy,MN)的无创性预测价值。方法回顾性纳入北部战区总医院肾脏病科PLA2R抗体阴性并行肾穿刺活检的糖尿病患者52例。符合条件的患者根据临床病理特点分为糖尿病肾脏疾病(diabetic kidney disease,DKD)组(n=22)与MN伴/不伴DKD(MN±DKD)组(n=22)。使用多因素Logistic回归模型等方法评估MN的危险因素。通过受试者工作特征曲线来估计IgG/C3的最佳预测值。结果DKD组血尿素氮为(9.34±3.48)mmol/L,显著高于MN±DKD组的(6.88±2.44)mmol/L(P<0.05)。DKD组血肌酐为(159.68±94.08)μmol/L,显著高于MN±DKD组的(102.20±53.94)μmol/L(P<0.05)。DKD组IgG为(8.45±2.12)g/L,显著高于MN±DKD组的(5.85±2.65)g/L(P<0.01)。DKD组IgG/C3为(7.57±2.05),显著高于MN±DKD组的(4.66±1.77)(P<0.01)。DKD组糖尿病病程为(7.11±6.02)年,显著高于MN±DKD组的(3.80±4.34)年(P<0.05)。DKD组糖尿病视网膜病变比例(72.73%)显著高于MN±DKD组(18.18%)(P<0.01)。多因素Logistic回归显示血清IgG/C3水平(OR=0.411;95%CI:0.185~0.910;P=0.028)是糖尿病合并MN的独立预测因素。受试者工作特征曲线分析显示,IgG/C3预测糖尿病合并MN的最佳临界值为6.098,敏感度为77.3%,特异度为77.3%,IgG/C3≤6.098为糖尿病合并MN的最佳预测值。结论糖尿病患者表现为血清PLA2R抗体阴性的单纯蛋白尿时,IgG/C3水平降低是MN的独立预测指标,有进一步进行肾穿刺活检的必要。Objective To detect the level of serum immunoglobulin(Ig)G/C3 in diabetes melli-tus(DM)patients with proteinuria and negative serum T-type phospholipase A2 receptor(PLA2R)anti-body and explore its non-invasive predictive value for membranous nephropathy(MN).Methods A to-tal of 52 DM patients with negative serum PLA2R antibody undergoing renal biopsy were retrospectively reviewed.The eligible subjects were assigned into two groups of diabetic kidney disease(DKD,n=22)and MN with/without DKD(MN±DKD,n=22)according to clinicopathological characteristics.Risk fac-tors for MN were evaluated by multivariate Logistic regression analysis.The optimal predictive value for IgG/C3 was estimated by receiver operator characteristic(ROC)curve.Results Blood urea nitrogen was significantly higher in DKD group than that in MN±DKD group[(9.34±3.48)vs(6.88±2.44)mmol/L](P<0.05).Blood creatinine became markedly elevated in DKD group than that in MN±DKD group[(159.68±94.08)vs(102.20±53.94)μmol/L](P<0.05).As compared with MN±DKD group,IgG[(8.45±2.12)vs(5.85±2.65)g/L](P<0.01),IgG/C3[(7.57±2.05)vs(4.66±1.77)](P<0.01),diabet-ic duration[(7.11±6.02)vs(3.80±4.34)year](P<0.05)and proportion of DKD(72.73%vs 18.18%)(P<0.01)were all significantly higher in DKD group than that in MN±DKD group.Multivariate Logistic regression indicated that serum IgG/C3 level(OR=0.411,95%CI:0.185-0.910,P=0.028)was an inde-pendent predictor of MN in diabetics.ROC curve indicated that the optimal cutoff value of IgG/C3 for pre-dicting MN was 6.098 with a sensitivity of 77.3%and a specificity of 77.3%.And IgG/C3≤6.098 was an optimal predictor of MN in diabetics.Conclusion Lower IgG/C3 level is an independent indicator of MN in diabetics with isolated proteinuria and negative serum PLA2R antibody.Renal biopsy is recom-mended for these patients.

关 键 词：膜性肾病 糖尿病肾脏疾病 磷脂酶A2受体 免疫球蛋白G 

分 类 号：R692.9[医药卫生—泌尿科学] R587.2[医药卫生—外科学]