肾上腺皮质激素联合免疫抑制剂治疗膜性肾病的疗效及与血清PLA2R抗体浓度的相关性

发布时间：2018-05-11 03:06

本文选题：特发性膜性肾病 + 磷酯酶A　；参考：《广东医学》2017年12期

【摘要】：目的探讨血清中M型磷脂酶A2受体(PLA2R)抗体的初始水平与特发性膜性肾病(IMN)患者免疫治疗疗效的相关性。方法选取79例经肾活检穿刺诊断为IMN的患者,根据治疗前血清PLA2R抗体水平的不同将其分为高浓度组和低浓度组;采用足量糖皮质激素联合环磷酰胺治疗12个月,分别检测两组患者治疗前后的24 h尿蛋白定量、血清白蛋白、血肌酐、血总胆固醇及血尿酸的水平,每2个月重复检测,统计学分析治疗前后两组患者各项指标的变化;治疗结束后评价并比较两组的治疗效果。结果治疗后PLA2R抗体低浓度组疗效分布与高浓度组差异有统计学意义(P0.01);与治疗前相比,两组患者治疗后24 h尿蛋白定量下降,血清白蛋白水平上升,差异均有统计学意义(P0.05)。治疗过程中低浓度组24 h尿蛋白下降程度和时间及血清白蛋白上升程度和时间均优于高浓度组,且差异有统计学意义(P0.05)。结论 IMN患者治疗前的血清PLA2R抗体的初始浓度与治疗疗效呈负相关,对预测患者临床缓解时间及缓解率具有一定的参考价值。
[Abstract]:Objective to investigate the relationship between the initial level of PLA2R antibody in serum and the immunotherapy efficacy of idiopathic membranous nephropathy (IMN). Methods Seventy-nine patients with IMN diagnosed by renal biopsy were divided into high concentration group and low concentration group according to the level of serum PLA2R antibody before treatment, and were treated with adequate glucocorticoid combined with cyclophosphamide for 12 months. The levels of 24 h urine protein, serum albumin, serum creatinine, serum total cholesterol and serum uric acid were measured before and after treatment. The therapeutic effects of the two groups were evaluated and compared after the treatment. Results there was a significant difference in the distribution of therapeutic effect between the low concentration group of PLA2R antibody and the high concentration group after treatment (P 0.01), compared with that before treatment, the urine protein quantity decreased and the serum albumin level increased in the two groups at 24 h after treatment, and the difference was statistically significant (P 0.05). During the course of treatment, the degree and time of 24 h urinary protein decrease and the increase of serum albumin in the low concentration group were better than those in the high concentration group, and the difference was statistically significant (P 0.05). Conclusion the initial concentration of serum PLA2R antibody in patients with IMN is negatively correlated with the therapeutic efficacy, and it has certain reference value in predicting the clinical remission time and remission rate.
【作者单位】：河南省人民医院肾病风湿免疫科;
【分类号】：R692

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