中国全科医学2016，Vol.19Issue(14)：1647-1652,6.DOI:10.3969/j.issn.1007-9572.2016.14.009
血清抗M型磷脂酶A2受体抗体对成年人特发性膜性肾病诊治的指导作用
Role of M _ type Phospholipase A2 Receptor Antibody in the Diagnosis and Treatment of Idiopathic Membranous Nephropathy in Adults
摘要
Abstract
Objective To evaluate the role of M _ type phospholipase A2 receptor antibody( anti-PLA2R) in the diagnosis and treatment of idiopathic membranous nephropathy(IMN)in adults. Methods From January 2014 to May 2015, we enrolled 58 patients who were definitely diagnosed with glomerular disease by renal biopsy in the First Affiliated Hospital of Guangzhou University of Chinese Medicine. Among them,there were 31 IMN patients(IMN group)and 27 non _ IMN patients (non _ IMN group). ELISA method was used to detect serum anti-PLA2R,in order to determine anti-PLA2R was positive or negative. Comparison was made between IMN group and non _ IMN group in the general data,laboratory examination indexes〔24 h UTP,Alb,Scr,urine RBC( HPF),UA,PT,INR,APTT and FIB〕,pathological indexes( mesangial proliferation, crescent formation,glomerulosclerosis,tubular atrophy/ fibrosis,renal interstitial inflammatory cell infiltration,renal interstitial vascular disease and immunofluorescence deposition) and clinical outcomes and the same comparison was made between anti-PLA2R positive and anti-PLA2R negative. Results In IMN group,there were 21 patients with anti-PLA2R positive with a positive rate of 67. 7%. In non _ IMN group,there was one patient with anti-PLA2R positive with a positive rate of 3. 7% . IMN group was higher in age,the optical density of serum anti-PLA2R and lower in urine RBC(HPF),PT,INR and APTT than non _ IMN group(P < 0. 05). The two groups were not significantly different in gender,MAP,UTP,Alb,Scr,UA and FIB (P > 0. 05). Patients with serum anti-PLA2R positive were higher than patients with anti-PLA2R negative in the optical density of serum anti-PLA2R(P < 0. 05). The two groups were not significantly different in gender,age,length of disease,MAP, UTP,Alb and Scr( P > 0. 05). Spearman correlation analysis showed that the optical density of serum anti-PLA2R had no correlation with MAP,UTP,Alb and Scr(rs = 0. 097, _ 0. 208,0. 266, _ 0. 358;P > 0. 05). Patients with anti-PLA2R positive and patients with anti-PLA2R negative were not significantly different in mesangial proliferation,crescent formation, glomerulosclerosis,tubular atrophy / fibrosis,renal interstitial inflammatory cell infiltration,renal interstitial vascular disease and the positive rates of IgA and C3 ( P > 0. 05). Among patients with anti-PLA2R positive,5 patients(23. 8% )received immunosuppressor therapy,and among patients with anti-PLA2R negative,5 patients(50. 0% )received immunosuppressor therapy. The two groups were not significantly different in the rate of receiving immunosuppressor therapy(P = 0. 222). Among patients with anti-PLA2R positive,12 patients finished follow _ up,and 4 patients had urine protein alleviated,and among patients with anti-PLA2R negative,7 patients finished follow _ up,and 6 patients had urine protein alleviated. The two groups were significantly different in the alleviation rate of urine protein(P = 0. 028). Conclusion Anti-PLA2R in serum can be used in the diagnosis of IMN and non _ IMN. For IMN patients,the detection of the antibody is helpful for predicting the development of the disease before and amid treatment.关键词
肾小球肾炎, 膜性/抗M型磷脂酶A2受体抗体/治疗Key words
Glomerulonephritis,membranous/Anti-PLA2R antibody/Therapy分类
医药卫生引用本文复制引用
鲁欢,汤水福,陈刚毅,苏保林,吴兴波,王超,涂海涛,罗月中..血清抗M型磷脂酶A2受体抗体对成年人特发性膜性肾病诊治的指导作用[J].中国全科医学,2016,19(14):1647-1652,6.基金项目
国家自然科学基金资助项目 （）
