血清抗M型磷脂酶A2受体抗体与膜性肾病表现及治疗反应的关系

发布时间：2018-04-04 20:24

本文选题：肾小球肾炎　切入点：膜性　出处：《中国老年学杂志》2017年14期

【摘要】：目的探讨血清抗M型磷脂酶A2受体(PLA2R)抗体与特发性膜性肾病(IMN)的临床表现、病理改变及治疗反应等的关系。方法选取经活检明确诊断为IMN患者56例,应用酶联免疫吸附法(ELISA)检测其血清抗M型PLA2R抗体,根据检测结果将患者分为抗PLA2R抗体阳性组和阴性组,回顾性分析两组临床和病理资料特点及对免疫抑制治疗的反应。结果 56例IMN患者中抗PLA2R抗体阳性率为71.43%;阳性组血清白蛋白水平低于阴性组、24 h尿蛋白水平高于阴性组(P0.05)。阳性组中肾病综合征(NS)患者的比例高于阴性组(P0.05)。阳性组肾组织Ig G1亚型荧光强度≥嘌患者比例低于阴性组(P=0.015);Ig G4亚型荧光强度≥嘁患者比例高于阴性组(P=0.022);PLA2R阳性表达者比例高于阴性组(P=0.015)。结论血清抗PLA2R抗体在IMN患者中阳性率较高,有助于协助IMN疾病的诊断。抗体阳性的IMN患者更易表现为NS,并与IMN的病情相关。血清抗PLA2R抗体阳性患者肾组织更多地表现为Ig G4亚型的强阳性沉积及PLA2R的阳性表达。但基线抗PLA2R抗体与IMN患者对免疫抑制治疗的反应无关。
[Abstract]:Objective to investigate the relationship between serum anti type phospholipase A 2 receptor (PLA 2 R) antibody and idiopathic membranous nephropathy (IMN) in patients with idiopathic membranous nephropathy (IMN).Methods 56 patients with IMN diagnosed by biopsy were selected and their serum anti-M PLA2R antibodies were detected by Elisa. According to the results, the patients were divided into two groups: positive group and negative group.The clinical and pathological features of the two groups and their responses to immunosuppressive therapy were analyzed retrospectively.Results the positive rate of anti PLA2R antibody was 71.43 in 56 patients with IMN, and the serum albumin level in positive group was lower than that in negative group after 24 h urine protein level was higher than that in negative group.The proportion of patients with NSN in positive group was higher than that in negative group (P 0.05).Conclusion the positive rate of anti-PLA2R antibody in IMN patients is higher, which is helpful for the diagnosis of IMN disease.IMN patients with positive antibodies were more likely to present NSs and were associated with IMN.The strong positive deposition of IgG4 subtype and the positive expression of PLA2R in the renal tissue of the patients with anti PLA2R antibody positive were observed.But baseline anti-PLA2R antibodies were not associated with the response of IMN patients to immunosuppressive therapy.
【作者单位】：吉林大学中日联谊医院肾内科;吉林大学中日联谊医院血液科;
【基金】：国家自然科学基金面上项目(81370810) 吉林省科技厅自然科学基金项目(20160101059JC)
【分类号】：R692

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