目的：探讨成人特发性膜性肾病（ IMN）与分泌型磷脂酶A2-ⅠB（ sPLA2-ⅠB）、抗磷脂酶A2受体抗体（Anti-PLA2R AB）的相关性。方法选取2013年7—12月武汉大学人民医院、福建医科大学附属第一医院经肾活检证实的成人IMN、继发性膜性肾病（ SMN）患者共30例，其中IMN 20例、SMN 10例，另选取同时期体检健康的志愿者5例为对照组。根据24 h尿蛋白总量分为低蛋白尿组7例、中蛋白尿组11例、高蛋白尿组17例。酶联免疫吸附试验（ ELISA）法检测血清sPLA2-ⅠB水平；免疫组化法检测肾脏sPLA2-ⅠB表达；间接免疫荧光法检测血清Anti-PLA2R AB表达。结果 IMN组和SMN组血清sPLA2-ⅠB水平高于对照组（ P＜0.05）；IMN组与SMN组血清sPLA2-ⅠB水平比较，差异无统计学意义（ P＞0.05）。IMN和SMN患者血清sPLA2-ⅠB水平与年龄、24 h尿蛋白总量呈正相关（r值分别为0.475和0.581，P值分别为0.008和0.002），与血清总蛋白、清蛋白呈负相关（r值分别为-0.487和-0.473，P 值分别为0.009和0.011）；多元线性回归分析结果显示，年龄、24 h 尿蛋白总量与血清sPLA2-ⅠB水平呈独立正相关（P＜0.05）。高蛋白尿组血清sPLA2-ⅠB水平、sPLA2-ⅠB阳性区域面积占肾小球区域面积比例高于低蛋白尿组和中蛋白尿组，中蛋白尿组血清sPLA2-ⅠB水平、sPLA2-ⅠB阳性区域面积占肾小球区域面积比例高于低蛋白尿组（P＜0.05）。IMN组Anti-PLA2R AB表达阳性率60%（12/20）高于SMN组的20%（2/10）（P＝0.039）。结论年龄、24 h尿蛋白总量与血清sPLA2-ⅠB水平呈独立正相关，血清sPLA2-ⅠB水平可能与IMN病情有一定相关性；IMN患者血清Anti-PLA2R AB阳性率高于SMN患者，提示Anti-PLA2R AB可能是IMN的特异性抗体，且有助于IMN与SMN的鉴别诊断。%Objective To investigate the correlation of secreted phospholipase A2 -ⅠB( sPLA2-ⅠB)and anti-phospholipase A2 receptor antibody ( Anti - PLA2R AB ) with idiopathic membranous nephropathy ( IMN ) in adult patients. Methods 20 adult patients with IMN,and 10 adult patients with secondary membranous nephropathy( SMN)who were admitted to the People′s Hospital of Wuhan University and the First Affiliated Hospital of Fujian Medical University from July to December in 2013,were selected as study subjects,the diseases of cases were confirmed by renal biopsy,5 healthy volunteers were included in control group at the same time. The enrolled cases were divided into low proteinuria group(7 cases),middle proteinuria group(11 cases) and high proteinuria group(17 cases)according to 24-hour proteinuria. Serum sPLA2-ⅠB level was assessed by ELISA, the expression of sPLA2-ⅠB in kidney was detected by immunohistochemistry. Serum Anti-PLA2R AB level was detected by the indirect immunofluorescence test. Results Serum sPLA2-ⅠB level in IMN group and in SMN group was significantly higher than that in control group, respectively( P <0. 05 ) . There was no significant difference in serum sPLA2-ⅠB level between IMN group and SMN group(P>0. 05). For IMN patients and SMN patients,the concentration of serum sPLA2-ⅠB was positively correlated with age and 24-hour proteinuria,respectively( r=0. 475,P=0. 008;r=0. 581,P=0. 002),and was negatively correlated with serum total protein and serum albumin,respectively(r= -0. 487,P=0. 009;r= -0. 473,P=0. 011). According to the results of multivariate linear regression analysis,age and 24-hour proteinuria was independently correlated with serum sPLA2-ⅠB level,respectively(P <0. 05). The concentration of serum sPLA2-ⅠB and the proportion of sPLA2-ⅠB positive area to total glomerulus area in high proteinuria group were significantly higher than those in middle proteinuria group and in low proteinuria group,respectively(P<0. 05),and the above two indicators in middle proteinuria group were significantly higher than those in low proteinuria group,respectively(P<0. 05). The expression rate of Anti-PLA2R AB in IMN group was 60%(12/20),which was significantly higher than that(20%,2/10)in SMN group( P = 0. 039 ) . Conclusion Age and 24 - hour proteinuria were independent influence factors for concentration of serum sPLA2-ⅠB . The level of serum sPLA2-ⅠB is possibly correlated with the progress of IMN. The expression rate of Anti-PLA2R AB among IMN patients is significantly higher than that among SMN patients,which indicates that Anti-PLA2R AB maybe the specific antibody of IMN,and Anti-PLA2R AB may contribute to the differential diagnosis of IMN and SMN.
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