PLA2R、 THSD7A与IgG亚型在特发性膜性肾病中的诊断价值

目的探讨特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者血清抗磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体水平、肾小球PLA2R、1型血小板反应蛋白7A域(thrombospondin type I domain containing 7A,THSD7A)、免疫球蛋白G(immunoglobulin G,IgG)亚型的表达及其在IMN中的诊断价值。方法选取2016年1月至2019年6月在雅安市人民医院肾内科经肾活检并确诊的IMN患者72例,以同期72例非IMN肾小球疾病患者为对照。采用酶联免疫吸附法检测血清抗PLA2R抗体滴度,免疫荧光法检测肾小球PLA2R、THSD7A及IgG亚型表达。采用受试者工作特征(ROC)曲线分析血清抗PLA2R抗体、肾小球PLA2R、THSD7A、IgG4诊断IMN的价值。结果血清抗PLA2R抗体、肾小球PLA2R、IgG4、THSD7A诊断IMN的灵敏度分别为61.11%、80.56%、97.22%、8.33%,特异度分别为97.22%、100.00%、97.22%、100.00%。血清抗PLA2R抗体和肾小球PLA2R任一指标阳性即诊断IMN的敏感性为83.33%;肾小球PLA2R、THSD7A和IgG4中任一指标阳性即诊断IMN的敏感性为97.22%。结论血清抗PLA2R抗体、肾小球PLA2R、THSD7A及IgG4亚型对于IMN诊断具有较高的临床价值。血清抗PLA2R抗体及肾小球PLA2R抗原的联合检测,肾小球PLA2R、THSD7A与IgG4的联合检测可以增加IMN诊断的敏感性。

Diagnostic value of PLA2R,THSD7A and IgG subtypes in idiopathic membranous nephropathy

Objective To investigate the expression of serum anti-phospholipase A2 receptor(PLA2R)antibody,glomerular PLA2R,type 1 platelet reactive protein 7A domain(THSD7A)and IgG subtype in patients with idiopathic membranous nephropathy(IMN)and their diagnostic value for IMN.Methods A total of 72 patients with IMN,diagnosed by renal biopsy in Department of Nephrology,Ya’an People’s Hospital from January of 2016 to June of 2019,were selected,and another 72 patients with non-IMN glomerular diseases in the same period were taken as the control group.Quantitative enzyme-linked immunosorbent assay(ELISA)was used to detect anti-PLA2R antibody titer.Immunofluorescence test(IFT)was used to detect the expression of glomerular PLA2R,THSD7A and IgG subtype.Receiver operator characteristic curves(ROC)were used to evaluate the diagnostic efficiency of serum anti-PLA2R antibodies,glomerular PLA2R,THSD7A and IgG4.Results The sensitivity of IMN diagnosis with serum anti-PLA2R antibody,glomerular PLA2R,IgG4 and THSD7A was 61.11%,80.56%,97.22%and 8.33%,respectively,and the specificity was 97.22%,100.00%,97.22%and 100.00%,respectively.If anyone of serum anti-PLA2R antibody and glomerular PLA2R was positive,the sensitivity of IMN diagnosis would be 83.33%.The sensitivity was 97.22%when IMN was diagnosed by any positive one of glomerular PLA2R,THSD7A and IgG4.Conclusions Serumanti-PLA2R antibody,glomerular PLA2R,THSD7A and IgG4 play an important role in the diagnosis and differential diagnosis of IMN.Detecting both PLA2R and its antibodies may increase the diagnostic accuracy of IMN.The combined detection of glomerular PLA2R,THSD7A and IgG4 can increase the sensitivity of IMN diagnosis.