血清抗磷脂酶A2受体抗体在特发性膜性肾病诊断中的意义以及免疫抑制治疗的疗效观察
发布时间：2018-10-26 15:29
【摘要】：目的:探讨血清抗磷脂酶A2受体(anti-phospholipase A2 receptor,PLA2R)抗体诊断特发性膜性肾病(Idiopathic Membranous Nephropathy,IMN)的价值以及他克莫司(tacrolimus,TAC)与环磷酰胺(cyclophosvnamide,CTX)治疗IMN的疗效比较。方法:收集2015年4月至2016年11月就诊于新疆医科大学第一附属医院肾病科,同时行肾穿刺活检及血清抗PLA2R抗体检测的282例患者,采用灵敏度、特异度、Kappa系数等指标分析血清抗PLA2R抗体水平与肾活检组织病理诊断结果的相关性。以及对经他克莫司治疗和经环磷酰胺治疗的IMN患者,定期监测24h尿蛋白定量、血浆白蛋白、血白细胞、肾功能、血脂等指标,对患者治疗期间的缓解率等进行观察。结果:1)同时行肾穿刺活检及血清抗PLA2R抗体检测的282例患者中,男性人数多于女性(男性=149例,女性=133例,各占52.8%、47.2%);汉族人数多于少数民族(汉族162例,维吾尔族81例,其他民族39例);年龄分布区间为14-72岁,平均年龄为(38.95±12.79)岁。性别、民族在IMN组与非特发性膜性肾病(Non-Idiopathic Membranous Nephropathy,Non-IMN)组间无统计学差异,P0.05;2)282例肾活检患者中,100例病理诊断为膜性肾病,其中78例抗PLA2R抗体阳性、22例阴性,而该抗体在肾穿刺确诊为非IMN的182例患者中,仅有2例阳性。该抗体检测IMN的灵敏度为78.0%;特异度为98.9%;血清抗磷脂酶A2受体(PLA2R)抗体诊断膜性肾病的符合率为78.0%。3)治疗前,TAC组与CTX组的24h尿蛋白定量、血浆白蛋白、血白细胞、肾功能、血脂等指标的差异均无统计学意义(P0.05);两组治疗3个月、6个月后,24h尿蛋白定量及血浆白蛋白水平较治疗前明显好转(P0.05);治疗6个月后,TAC组与CTX组相比,24h尿蛋白定量较低,血浆白蛋白较高,差异均有统计学意义(均P0.05)。4)治疗6个月,TAC组的部分缓解率及总缓解率明显高于CTX组(P0.05)。结论:血清抗PLA2R抗体可作为IMN的特异性标志物,可用于疾病的诊断,是有潜力的诊断治疗指标。TAC和CTX对IMN的治疗均有一定的疗效;治疗6个月时,TAC的疗效及缓解率明显优于CTX。
[Abstract]:Objective: to evaluate the value of serum anti-phospholipase A2 receptor (anti-phospholipase A2 receptor,PLA2R) antibody in the diagnosis of idiopathic membranous nephropathy (Idiopathic Membranous Nephropathy,IMN) and to compare the efficacy of tacrolimus (tacrolimus,TAC) and cyclophosphamide (cyclophosvnamide,CTX) in the treatment of IMN. Methods: from April 2015 to November 2016, 282 patients with renal diseases in the first affiliated Hospital of Xinjiang Medical University were examined by renal biopsy and serum anti PLA2R antibody. The correlation between serum anti-PLA2R antibody level and pathological diagnosis of renal biopsy was analyzed by Kappa coefficient. IMN patients treated with tacrolimus and cyclophosphamide were regularly monitored for 24 hours urinary protein quantification, plasma albumin, white blood cell, renal function and blood lipid, and the remission rate during treatment was observed. Results: 1) the number of males was higher than that of females (male = 149, female = 133, 52.8%). The number of Han nationality is more than that of minority nationality (162 cases of Han nationality, 81 cases of Uygur nationality, 39 cases of other nationalities), the age distribution range is 14-72 years old, the average age is (38.95 卤12.79) years old. There was no significant difference in sex and nationality between IMN group and non-idiopathic membranous nephropathy (Non-Idiopathic Membranous Nephropathy,Non-IMN) group (P 0.05). 2) of 282 renal biopsy patients, 100 cases were diagnosed as membranous nephropathy, of which 78 cases were positive for anti PLA2R antibody, 22 cases were negative, but only 2 cases were positive in 182 cases of non IMN diagnosed by renal biopsy. The sensitivity of the antibody for detecting IMN was 78.0 and the specificity was 98.9. The coincidence rate of serum anti-phospholipase A2 receptor (PLA2R) antibody in the diagnosis of membranous nephropathy was 78.0.3) before treatment, 24 hours urine protein, plasma albumin, white blood cell, renal function were measured in TAC group and CTX group. There was no significant difference in blood lipid and other indexes (P0.05). After treatment for 3 months and 6 months, 24 h urinary protein and plasma albumin levels were significantly improved in both groups (P0.05). After 6 months of treatment, compared with CTX group, 24 hours urine protein quantity was lower and plasma albumin was higher in TAC group than that in CTX group, the difference was statistically significant (P0.05) for 6 months. The partial remission rate and total remission rate of TAC group were significantly higher than that of CTX group (P0.05). Conclusion: serum anti PLA2R antibody can be used as a specific marker of IMN, can be used in the diagnosis of disease, and is a potential diagnostic and therapeutic index. Both TAC and CTX have a certain therapeutic effect on IMN. After 6 months of treatment, the curative effect and remission rate of TAC were significantly better than those of CTX..
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692
本文编号：2296172
[Abstract]:Objective: to evaluate the value of serum anti-phospholipase A2 receptor (anti-phospholipase A2 receptor,PLA2R) antibody in the diagnosis of idiopathic membranous nephropathy (Idiopathic Membranous Nephropathy,IMN) and to compare the efficacy of tacrolimus (tacrolimus,TAC) and cyclophosphamide (cyclophosvnamide,CTX) in the treatment of IMN. Methods: from April 2015 to November 2016, 282 patients with renal diseases in the first affiliated Hospital of Xinjiang Medical University were examined by renal biopsy and serum anti PLA2R antibody. The correlation between serum anti-PLA2R antibody level and pathological diagnosis of renal biopsy was analyzed by Kappa coefficient. IMN patients treated with tacrolimus and cyclophosphamide were regularly monitored for 24 hours urinary protein quantification, plasma albumin, white blood cell, renal function and blood lipid, and the remission rate during treatment was observed. Results: 1) the number of males was higher than that of females (male = 149, female = 133, 52.8%). The number of Han nationality is more than that of minority nationality (162 cases of Han nationality, 81 cases of Uygur nationality, 39 cases of other nationalities), the age distribution range is 14-72 years old, the average age is (38.95 卤12.79) years old. There was no significant difference in sex and nationality between IMN group and non-idiopathic membranous nephropathy (Non-Idiopathic Membranous Nephropathy,Non-IMN) group (P 0.05). 2) of 282 renal biopsy patients, 100 cases were diagnosed as membranous nephropathy, of which 78 cases were positive for anti PLA2R antibody, 22 cases were negative, but only 2 cases were positive in 182 cases of non IMN diagnosed by renal biopsy. The sensitivity of the antibody for detecting IMN was 78.0 and the specificity was 98.9. The coincidence rate of serum anti-phospholipase A2 receptor (PLA2R) antibody in the diagnosis of membranous nephropathy was 78.0.3) before treatment, 24 hours urine protein, plasma albumin, white blood cell, renal function were measured in TAC group and CTX group. There was no significant difference in blood lipid and other indexes (P0.05). After treatment for 3 months and 6 months, 24 h urinary protein and plasma albumin levels were significantly improved in both groups (P0.05). After 6 months of treatment, compared with CTX group, 24 hours urine protein quantity was lower and plasma albumin was higher in TAC group than that in CTX group, the difference was statistically significant (P0.05) for 6 months. The partial remission rate and total remission rate of TAC group were significantly higher than that of CTX group (P0.05). Conclusion: serum anti PLA2R antibody can be used as a specific marker of IMN, can be used in the diagnosis of disease, and is a potential diagnostic and therapeutic index. Both TAC and CTX have a certain therapeutic effect on IMN. After 6 months of treatment, the curative effect and remission rate of TAC were significantly better than those of CTX..
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692
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