联合检测血清PLA2R、IgG4对特发性膜性肾病诊断的临床价值分析  

Clinical value of serum PLA2R and IgG4 complexes in diagnosis of idiopathic membranous nephropathy

作　　者：王杰 王霞 李静[1] 李燕燕 花淑婷 孙亚坤 WANG Jie;WANG Xia;LI Jing;LI Yan-yan;HUA Shu ting;SUN Ya-kun(Department of nephrology,the Second People's Hospital of Jiaozuo,Jiaozuo,Henan 454000,China)

机构地区：[1]焦作市第二人民医院肾内科,河南焦作454000

出　　处：《医药论坛杂志》2024年第23期2532-2536,共5页Journal of Medical Forum

摘　　要：目的探究血清M型磷脂酶A2受体(M-type phospholipase A2 receptor,PLA2R)和免疫球蛋白G亚群4(Immunoglobulin G4,IgG4)在特发性膜性肾病(idiopathic membranous nephropathy,IMN)诊断中的临床价值。方法回顾性选取2020年2月至2021年2月焦作市第二人民医院收治的经肾活检确诊为MN患者115例为研究对象。根据肾穿刺活检结果将患者分为继发性膜性肾病继发性膜性肾病(secondary membranous nephropathy,SMN)和特发性膜性肾病(IMN),分别为72例、43例。选取30名同期在医院接受检查的健康人作为对照组。使用全自动化学发光免疫分析仪测定三组研究对象血清肌酐水平、24h尿蛋白定量、血浆白蛋白水平及肾小球滤过率,采用ELISA法检测三组研究对象血清抗PLA2R抗体阳性率、血清抗PLA2R与IgG4水平,并通过ROC曲线分析PLA2R、IgG4与联合检测诊断IMN价值。结果自动化学发光免疫分析结果显示,IMN和SMN组患者血浆白蛋白浓度和肾小球滤过率均明显低于对照组,差异有统计学意义(P<0.05)。ELISA结果显示,与SMN组和对照组相比,IMN组血清中抗PLA2R抗体阳性百分比以及血清中抗PLA2R和IgG4水平差异有统计学意义(P<0.05),ROC曲线分析显示,PLA2R、IgG4对IMN患者诊断的AUC分别为0.879、0.844,均具有准确性;诊断敏感度、特异度:PLA2R为91.7%、74.0%;IgG4为91.7%、71.2%。PLA2R和IgG4水平被纳入逻辑回归模型,以计算综合检测值,两项联合诊断AUC为0.903,敏感度、特异度为87.5%、89.0%,诊断价值较高。结论血清PLA2R、IgG4在特发性膜性肾病的诊断中均具有较高价值,联合检测诊断准确性更高,值得临床推广。Objective To investigate the clinical value of simultaneous detection of serum PLA2R and IgG4 in the diagnosis of idiopathic membranous nephropathy IMN.Methods From February 2020 to February 2021,115 MN patients were diagnosed by renal biopsy.According to the results of renal biopsy,the patients were divided into IMN(n=72)and SMN groups(n=43).In addition,30 cases of health personnel were selected as control group.Serum creatinine level,24 h urine protein quantification,plasma albumin level and glomerular filtration rate were measured by automatic chemiluminescence immunoanalyzer.The positive rate of anti PLA2R antibody,serum anti PLA2R and IgG4 level of the three groups were detected by ELISA method.The diagnosis vaule of PLA2R,IgG4 and combined detection was analysed by ROC curve.Results A Automated chemiluminescence immunoassay results showed that the plasma albumin concentration and glomerular filtration rate in patients of the IMN and SMN groups were significantly lower than those of the control group,and the differences were statistically significant(P<0.05).ELISA results showed compared with the SMN group and the control group,the positive percentage of anti-PLA2R antibodies in serum and the levels of anti-PLA2R and IgG4 in serum in the IMN group had statistically significant differences(P<0.05).ROC curve analysis showed the AUC of PLA2R and IgG4 for the diagnosis of IMN patients were 0.879 and 0.844 respectively,both of which were accurate;for diagnostic sensitivity and specificity,PLA2R was 91.7%and 74.0%respectively;IgG4 was 91.7%and 71.2%respectively.The levels of PLA2R and IgG4 were included in the logistic regression model to calculate the comprehensive detection value.The AUC for the combined diagnosis of these two items was 0.903,and the sensitivity and specificity were 87.5%and 89.0%respectively,indicating a relatively high diagnostic value.Conclusion Serum PLA2R and IgG4 have high diagnostic value in idiopathic membranous nephropathy,and combined detection can improve diagnostic accuracy,which is

关 键 词：特发性膜性肾病 M型磷脂酶A2受体 免疫球蛋白G亚组4 联合检测 临床诊断价值 

分 类 号：R692[医药卫生—泌尿科学]