血清PLA2R抗体与原发性膜性肾病临床病理的关系  

Relationship between serum PLA2R antibody and clinicopathology of primary membranous nephropathy

作　　者：钟兰星 梁新华 ZHONG Lan-xing;LIANG Xin-hua(Department of Nephrology and Rheumatology,Shenzhen Hospital of Southern Medical University,Shenzhen 518100,Guangdong,CHINA)

机构地区：[1]南方医科大学深圳医院肾内风湿科,广东深圳518100

出　　处：《海南医学》2025年第2期176-180,共5页Hainan Medical Journal

摘　　要：目的探讨血清抗磷酸脂酶A2受体(PLA2R)与原发性膜性肾病临床病理的关系,为临床原发性膜性肾病的诊治提供依据。方法回顾性分析2019年1月至2023年12月期间南方医科大学深圳医院收治的76例原发性膜性肾病患者的临床资料,根据患者血清PLA2R抗体是否阳性进行分组,其中39例血清PLA2R抗体滴度水平≥14RU/mL者纳入阳性组,余37例<14RU/mL者纳入阴性组。比较两组患者的临床资料及病理检查资料(光镜及免疫荧光)。结果阳性组患者的血尿酸水平为(369.40±84.97)μmoI/L,明显低于阴性组的(412.62±100.38)μmoI/L,尿蛋白定量为(3742.64±634.16)mg,明显高于阴性组的(3060.92±624.51)mg,差异均有统计学意义(P<0.05);两组患者的间膜性肾病分期、免疫球蛋白G亚型4(IgG4)、免疫球蛋白M(IgM)、血清补体C1q、系膜细胞增生比较差异均有统计学意义(P<0.05),其余指标组间比较差异均无统计学意义(P>0.05)。结论原发性膜性肾病患者中PLA2R抗体阳性者临床表现更重,肾组织IgG4阳性率较高,患者更易出现水肿和肾病综合征。Objective To investigate the relationship between serum antiphospholipase A2 receptor(PLA2R)and the clinicopathology of primary membranous nephropathy,and to provide basis for the clinical diagnosis and treatment of primary membranous nephropathy.Methods The clinical data of 76 patients with primary membranous nephropathy admitted to Shenzhen Hospital of Southern Medical University from January 2019 to December 2023 were retrospectively analyzed.The patients were grouped according to whether their serum PLA2R antibody was positive or not.Thirty-nine patients with serum PLA2R antibody titer≥14 RU/mL were included in the positive group,and the remaining 37 patients with serum PLA2R antibody titer<14 RU/mL were included in the negative group.The clinical data and pathological examination data(light microscopy and immunofluorescence)of the two groups were compared.Results The serum uric acid level in the positive group was(369.40±84.97)μmoI/L,which was significantly lower than(412.62±100.38)μmoI/L in the negative group,and the urinary protein quantity was(3742.64±634.16)mg,which was significantly higher than(3060.92±624.51)mg in the negative group,with statistically significant differences(P<0.05).There were statistically significant differences in the stages of intermembranous nephropathy,immunoglobulin G subtype 4(IgG4),immunoglobulin M(IgM),serum complement C1q,and mesangial cell proliferation between the two groups(P<0.05),while there were no statistically significant differences in other indicators(P>0.05).Conclusion In patients with primary membranous nephropathy,patients with PLA2R antibody positive had more severe clinical manifestations,higher positive rate of IgG4 in renal tissue,and were more prone to edema and nephrotic syndrome.

关 键 词：肾病综合征 原发性膜性肾病 抗磷酸脂酶A2受体 免疫球蛋白G4 临床病理 

分 类 号：R692[医药卫生—泌尿科学]