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

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(P<0.05).阳性组中肾病综合征(NS)患者的比例高于阴性组(P<0.05).阳性组肾组织IgG1亚型荧光强度≥ (++)患者比例低于阴性组(P=0.015);IgG4亚型荧光强度≥ （++）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IgG4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.%Objective To investigate the relationship between serum anti-M-type phospholipase A2 receptor (PLA2R) antibody and clinical or pathological manifestations, and therapeutic response of idiopathic membranous nephropathy (IMN) as well.Methods A retrospective analysis was conducted, enrolling 56 patients with biopsy-proven IMN and serum anti-PLA2R antibody was detected by enzyme-linked immunoabsorbent assay (ELISA) methods.The 56 IMN patients were divided into antibody-positive and antibody-negative groups according to serum anti-PLA2R antibody detection.Clinical data, pathological features and the response to immunosuppressive therapy were analyzed.Results Among 56 IMN patients, 40 cases(71.43%) showed positive anti-PLA2R antibodies.The level of serum albumin in antibody-positive group was significantly lower than that in negative group and the level of 24 hours urinary protein in antibody-positive group was significantly higher than that in negative group (P<0.05).The percentage of nephrotic syndrome patients in antibody-positive group was significantly higher than that in negative group (P<0.05).The percentage of patients with immunofluorescence intensity ≥ （++） of IgG1 subtype deposition in renal tissue in antibody-positive group was lower than that in antibody-negative group (P=0.015).The percentage of patients with immunofluorescence intensity ≥ (++) of IgG4 subtype deposition in antibody-positive group was higher than that in antibody-negative group (P=0.022).The proportion of patients with renal PLA2R expression in antibody-positive group was higher than that in antibody-negative group (P=0.015).Conclusions The anti-PLA2R antibody detection may contribute to the diagnosis of IMN disease.The IMN patients with positive anti-PLA2R antibody are more likely to present nephrotic syndrome and the antibody is associated with disease conditions.The IMN patients with positive serum anti-PLA2R antibody are more likely to show the strong positive deposition of IgG4 subtype and expression of PLA2R in renal tissue;however, the baseline anti-PLA2R antibody is not associated with the response to immunosuppressive therapy.