血清抗ds-DNA抗体、TSH及尿IgG4水平与特发性膜性肾病患者免疫抑制治疗疗效的关系  

Relationship between serum anti-ds-DNA antibody,TSH and urinary IgG4 levels and the efficacy of immunosuppressive therapy in patients with idiopathic membranous nephropathy

作　　者：薛冉 吴斌 李国锻 XUE Ran;WU Bin;LI Guoduan(Department of Laboratory,Huzhou Nanxun District People's Hospital,Huzhou 313009,China;不详)

机构地区：[1]湖州市南浔区人民医院检验科,浙江湖州313009 [2]湖州市南浔区人民医院肾内科,浙江湖州313009

出　　处：《医师在线》2025年第3期48-52,共5页Journal of Doctors Online

摘　　要：目的探究特发性膜性肾病(IMN)患者血清抗双链脱氧核糖核酸(抗ds-DNA)抗体、促甲状腺素(TSH)以及尿免疫球蛋白G4(IgG4)水平与免疫抑制治疗疗效的关系。方法回顾性选择2020年1月~2023年10月期间于我院接受免疫抑制规范治疗的IMN患者92例,根据纳入和排除标准剔除12例,最终将80例符合标准的患者纳入研究。根据治疗6个月的临床疗效,将患者分为有效组(52例)和无效组(28例),比较两组患者的血清抗ds-DNA抗体、TSH水平以及尿IgG4水平,通过多因素Logistic回归模型分析影响IMN患者免疫抑制治疗效果的相关因素,并绘制受试者工作特征(ROC)曲线分析血清抗ds-DNA抗体、TSH及尿IgG4水平对免疫抑制治疗疗效的预测价值。结果无效组病理分期Ⅲ~Ⅳ期占比以及出现血尿患者占比显著高于有效组(P<0.05);无效组患者24 h尿蛋白定量(24 h U-TP)、白蛋白(ALB)、肌酐(Scr)、抗磷脂酶A2受体抗体(PLA2R-Ab)、抗ds-DNA抗体、TSH以及尿IgG4水平均显著高于有效组(P<0.05);肾小球滤过率(GFR)、总胆固醇(TC)则显著低于有效组(P<0.05);病理分期Ⅲ~Ⅳ期、出现血尿、PLA2R-Ab、抗ds-DNA抗体、血清TSH及尿IgG4水平升高是影响IMN患者免疫抑制治疗疗效的独立危险因素(P<0.05);血清抗ds-DNA抗体、TSH及尿IgG4联合检测预测IMN患者免疫治疗无效的ROC曲线下面积(AUC)为0.905,高于三者单独检测的AUC(分别为0.832、0.795、0.814)。结论IMN患者血清抗ds-DNA抗体、TSH及尿IgG4水平与其免疫抑制治疗效果有关,三者联合检测对早期预测IMN患者免疫抑制治疗疗效的价值较高。Objective To explore the relationship between serum anti-double-stranded deoxyribonucleic acid(anti-ds-DNA)antibody,thyroid stimulating hormone(TSH)and urinary immunoglobulin G4(IgG4)levels and the efficacy of immunosuppressive therapy in patients with idiopathic membranous nephropathy(IMN).Methods A total of 92 patients with IMN who received standard immunosuppressive therapy in our hospital from January 2020 to October 2023 were retrospectively selected.12 cases were excluded according to the inclusion and exclusion criteria,and finally 80 cases who met the criteria were included in the study.According to the clinical efficacy after 6 months of treatment,the patients were divided into an effective group(52 cases)and an ineffective group(28 cases).The serum anti-ds-DNA antibody,TSH level and urinary IgG4 level were compared between the two groups.The relevant factors affecting the efficacy of immunosuppressive therapy in IMN patients were analyzed by multivariate Logistic regression model.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum anti-ds-DNA antibody,TSH and urinary IgG4 levels in immunosuppressive therapy.Results The proportion of pathological stageⅢ~Ⅳand hematuria in the ineffective group was significantly higher than that in the effective group(P<0.05).The levels of 24 h urinary protein(24 h U-TP),albumin(ALB),creatinine(Scr),anti-phospholipase A2 receptor antibody(PLA2R-Ab),anti-ds-DNA antibody,TSH and urinary IgG4 in the ineffective group were significantly higher than those in the effective group(P<0.05),and the levels of glomerular filtration rate(GFR),total cholesterol(TC)were significantly lower than those of the effective group(P<0.05).Pathological stageⅢ~Ⅳ,hematuria,PLA2RAb,anti-ds-DNA antibody,serum TSH and urinary IgG4 levels were independent risk factors for IMN patients for the efficacy of immunosuppressive therapy(P<0.05).The area under the ROC curve(AUC)of the combined detection of serum anti-ds-DNA antibody,TSH and urine IgG4 to predi

关 键 词：特发性膜性肾病 抗双链脱氧核糖核酸抗体 促甲状腺素 免疫球蛋白G4 免疫抑制治疗 

分 类 号：R69[医药卫生—泌尿科学]