特发性膜性肾病患者尿抗磷脂酶A2受体、选择性蛋白尿指数、尿微量蛋白/尿肌酐比值水平变化的临床意义  

Clinical significance of changes in urinary phospholipase A2 receptor,selective proteinuria index and urinary albumin/creatinine ratio in patients with idiopathic membranous nephropathy

作　　者：李丽 代建风 聂文迪 吴子琴 曹敏 LI Li;DAI Jianfeng;NIE Wendi;WU Ziqin;CAO Min(Department of Emergency,Jiujiang Hospital of Traditional Chinese Medicine,Jiangxi Province,Jiujiang332000,China;Nropathy Research Laboratory,Jiujiang Hospital of Traditional Chinese Medicine,Jiangxi Province,Jiujiang332000,China;Department of Clinical Laboratory,Jiujiang Hospital of Traditional Chinese Medicine,Jiangxi Province,Jiujiang332000,China)

机构地区：[1]江西省九江市中医医院急诊科,江西九江332000 [2]江西省九江市中医医院肾病研究室,江西九江332000 [3]江西省九江市中医医院检验科,江西九江332000

出　　处：《中国当代医药》2025年第10期74-78,83,共6页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202211963)。

摘　　要：目的探究特发性膜性肾病(IMN)患者尿抗磷脂酶A2受体(PLA2R)、选择性蛋白尿指数(SPI)、尿微量蛋白/尿肌酐比值(UACR)水平变化的临床意义,以期为临床疾病的诊疗提供有效且准确的辅助指标。方法选取2022年9月至2024年9月在九江市中医医院经肾穿刺活检确诊的150例IMN患者作为IMN组,另选取同期在九江市中医医院体检的150名健康人群作为对照组,检测并比较两组尿PLA2R浓度、SPI以及UACR水平的差异。依据病理分期将IMN患者划分为Ⅰ期(n=48)、Ⅱ期(n=52)、Ⅲ期(n=30)、Ⅳ期(n=20)共4个亚组,比较不同病理分期IMN患者尿PLA2R浓度、SPI以及UACR水平的差异,采用Pearson等级相关分析IMN患者其尿PLA2R浓度、SPI与UACR水平之间的关系。绘制ROC曲线分析尿PLA2R、SPI、UACR单一及联合检测在IMN中的诊断效能。结果IMN组患者的尿PLA2R浓度、SPI、UACR水平均高于对照组,差异有统计学意义(P<0.05)。IMN患者的尿PLA2R水平均分别与SPI、UACR呈正相关(r=0.453、0.501,P<0.05),SPI与UACR也呈正相关(r=0.433,P<0.05)。Ⅰ期IMN患者的尿PLA2R浓度、SPI、UACR水平均低于Ⅱ期、Ⅲ期、Ⅳ期,Ⅱ期IMN患者的尿PLA2R浓度、SPI、UACR水平均低于Ⅲ期、Ⅳ期,Ⅲ期IMN患者的尿PLA2R浓度、SPI、UACR水平均低于Ⅳ期,差异有统计学意义(P<0.05)。ROC分析结果显示,尿PLA2R为0.04 mg/ml时,其诊断IMN的AUC为0.846(95%CI:0.800~0.885);SPI为0.09时,其诊断IMN的AUC为0.849(95%CI:0.803~0.887);UACR为212.23 mg/g时,其诊断IMN的AUC为0.808(95%CI:0.759~0.851);三者联合诊断IMN的AUC为0.946(95%CI:0.915~0.969),敏感度与特异度则分别为88.00%和89.93%。结论IMN患者的尿PLA2R浓度、SPI、UACR水平异常升高,且尿PLA2R浓度、SPI、UACR水平与患者临床病理分期存在关联,三者联合检测有助于提高临床IMN的诊断准确率。Objective To investigate the clinical significance of changes in urinary phospholipase A2 receptor(PLA2R),selective proteinuria index(SPI)and urinary albumin/creatinine ratio(UACR)in patients with idiopathic membranous nephropathy(IMN),in order to provide effective and accurate auxiliary indicators for the diagnosis and treatment of clinical diseases.Methods A total of 150 patients with IMN diagnosed by renal biopsy in Jiujiang Hospital of Traditional Chinese Medicine from September 2022 to September 2024 were selected as the IMN group,and 150 healthy people who underwent physical examination in Jiujiang Hospital of Traditional Chinese Medicine during the same period were selected as the control group.The differences in urinary PLA2R concentration,SPI and UACR levels between the two groups were detected and compared.According to the pathological stage,IMN patients were divided into four subgroups:stageⅠ(n=48),stageⅡ(n=52),stageⅢ(n=30)and stageⅣ(n=20).The differences of urinary PLA2R concentration,SPI and UACR levels in IMN patients with different pathological stages were compared.Pearson rank correlation was used to analyze the relationship between urinary PLA2R concentration,SPI and UACR in IMN patients.ROC curve was drawn to analyze the diagnostic efficacy of single and combined detection of urinary PLA2R,SPI and UACR in IMN.Results The urinary PLA2R concentration,SPI and UACR levels in IMN group were higher than those in control group,and the differences were statistically significant(P<0.05).The level of urinary PLA2R in IMN patients was positively correlated with SPI and UACR(r=0.453,0.501;P<0.05),and SPI was also positively correlated with UACR(r=0.433,P<0.05).The urinary PLA2R concentration,SPI and UACR levels of stageⅠIMN patients were lower than those of stageⅡ,ⅢandⅣIMN patients,the urinary PLA2R concentration,SPI and UACR levels of stageⅡIMN patients were lower than those of stageⅢandⅣIMN patients,and the urinary PLA2R concentration,SPI and UACR levels of stageⅢIMN patients were

关 键 词：特发性膜性肾病 尿抗磷脂酶A2受体 选择性蛋白尿指数 尿微量蛋白/尿肌酐比值 病理分期 诊断价值 

分 类 号：R692[医药卫生—泌尿科学]