M型磷脂酶A2受体相关检测在成人特发性膜性肾病诊断中的应用

摘要

目的 探讨血清抗M型磷脂酶A2受体(PLA2R)抗体和肾小球PLA2R联合检测在成人特发性膜性肾病诊断中的应用.方法 回顾性分析2015年1月-2016年1月就诊于郑州大学第一附属医院肾内科经肾穿刺活检术诊断为特发性膜性肾病(IMN)患者205例和非IMN患者89例的临床及实验室资料,包括血清抗PLA2R抗体和肾小球PLA2R检测结果.结果 IMN组血清抗PLA2R抗体阳性率为68.3%(140/205),肾小球PLA2R阳性率为71.7%(147/205),其中两者共阳性者52.2%(107/205),两者共阴性者12.2%(25/205),血清抗PLA2R抗体阳性而肾小球PLA2R阴性者16.1%(33/205),血清抗PLA2R抗体阴性而肾小球PLA2R阳性者19.5%(40/205).血清抗PLA2R抗体诊断IMN的敏感性为68.3%,特异性为96.6%,受试者工作特征(ROC)曲线下面积为0.859;肾小球PLA2R诊断IMN的敏感性为71.7%,特异性为83.1%,ROC曲线下面积为0.777,两者联合检测的ROC曲线下面积为0.878.结论 血清抗PLA2R抗体和肾小球PLA2R是诊断IMN既敏感又特异的指标,两者联合检测更有助于IMN的诊断.%Objective To explore the role of autoantibodies against phospholipase A2 receptor (PLA2R) and glomerular PLA2R in the diagnosis of idiopathic membranous nephropathy (IMN) in adult patients. Methods A retrospective study was taken. A total of 294 glomerulopathy patients were included in this study, consisting of 205 cases with IMN, 89 cases with non-IMN. Clinical and laboratory test data were collected, including the test of serum anti-PLA2R antibodies and glomerular PLA2R. Results About 68.3% IMN patients were detected with positive anti-PLA2R antibodies, positive PLA2R glomerular deposits were found in 71.7% IMN patients. Within the IMN group, 52.2% showed positive results of both serum anti-PLA2R antibodies and glomerular PLA2R, 12.2% showed negative results of both serum anti-PLA2R antibodies and glomerular PLA2R, 16.1% showed positive for serum anti-PLA2R antibodies but negative for glomerular PLA2R, 19.5%showed negative for serum anti-PLA2R antibodies but positive for glomerular PLA2R. The sensitivity of serum anti-PLA2R antibodies was 68.3% and the specificity was 96.6%, the area under ROC curve of anti-PLA2R antibody for IMN diagnosis was 0.859; the sensitivity of glomerular PLA2R was 71.7% and the specificity was 83.1%, the area under ROC curve of glomerular PLA2R for IMN diagnosis was 0.777, the area under ROC curve of combination of anti-PLA2R antibody and glomerular PLA2R was 0.878. Conclusions Serum anti-PLA2R antibodies and glomerular PLA2R are sensitive and specific tools in the diagnosis of IMN, the combined detection is more helpful in the diagnosis of IMN.