PLA2R和IgG4对老年原发性膜性肾病的诊断价值

摘要

Objective To evaluate the diagnostic significance of PLA2R and IgG4 in elderly patients with idiopathic membranous nephropathy (IMN).Methods The clinical data were retrospectively analyzed of patients with IMN (49 males and 49 females,aged 66.6 ± 5.4 years) or Non-IMN (57 males and 41 females,aged 67.1 ± 6.5 years) who were admitted in the authors served Department of Nephrology from Apr.2014 to Feb.2016 and accepted renal biopsy.SPSS13.0 was employed to evaluate the sensitivity,specificity and calculate the area under ROC curve (AUC) of serum anti-PLA2R antibody,glomerular PLA2R and IgG1-4 subclasses on diagnosing IMN.Results On diagnosing IMN,the sensitivity and specificity of serum anti-PLA2R antibody were 77.6％ and 89.8％ [AUC=0.869(0.816-0.923)],of glomerular PLA2R were 66.3％ and 94.9％ [AUC=0.805(0.741-0.87)],and of glomerular IgGl-IgG4 were 80.6％ and 78.6％,60.2％ and 83.7％,41.8％ and 84.7％,and 93.9％ and 89.8％,respectively [AUC=0.767(0.696-0.838),0.709(0.635-0.783),0.628(0.549-0.706) and 0.94(0.901-0.978),respectively].As to the combined use of glomerular PLA2R and IgG4 on diagnosing IMN,the sensitivity was 93.9％ when either one of glomerular PLA2R and IgG4 was positive,or the specificity was 96.9％ when both glomerular PLA2R and IgG4 were positive.Conclusion PLA2R and IgG4 can effectively serve the diagnosis of IMN,and the combined use of PLA2R and IgG4 may be better than single indicator alone.%目的 评估M型磷脂酶A2受体(PLA2R)和IgG4对老年原发性膜性肾病(IMN)的诊断价值.方法 纳入2014年4月-2016年2月在郑州大学第一附属医院肾内科进行肾活检的IMN(n=98)和非膜性肾病(Non-IMN,n=98)患者进行回顾性分析.男106例,女90例,年龄66.9±6.0岁.其中,IMN组男49例,女49例,年龄66.6±5.4岁;Non-IMN组男57例,女41例,年龄67.1±6.5岁.应用SPSS 13.0软件计算血清抗PLA2R抗体、肾小球PLA2R和IgG1-4亚类诊断IMN的敏感度、特异度和ROC曲线下面积(AUC).结果 通过计算ROC曲线得到如下结果:血清抗PLA2R抗体诊断IMN的敏感度和特异度分别为77.6％和89.8％[AUC=0.869(0.816～0.923)];肾小球PLA2R诊断IMN的敏感度和特异度分别为66.3％和94.9％ [AUC=0.805(0.741～0.870)];肾小球IgG1-4诊断IMN的敏感度和特异度分别为80.6％、60.2％、41.8％、93.9％和78.6％、83.7％、84.7％、89.8％[AUC分别为0.767(0.696～0.838)、0.709(0.635～0.783)、0.628(0.549～0.706)、0.94(0.901～0.978)];肾小球PLA2R抗体联合IgG4诊断IMN,两者任一阳性的敏感度为93.9％,两者共阳性的特异度高达96.9％.结论 PLA2R和IgG4能够有效诊断IMN,两者联合检验较单一指标更精确.