特发性膜性肾病患者血清抗磷脂酶A2受体抗体与尿中IgG4检测的临床意义

目的：探讨特发性膜性肾病（IMN）患者血清抗磷脂酶A2受体（PLA2R）抗体及尿IgG4检测的临床意义。方法：将90例膜性肾病（MN）患者按照病理类型分为特发性膜性肾病（IMN）组（52例）和继发性膜性肾病（SMN）组（38例）；另选同期体检健康者35例作为对照组。检测各组血清抗PLA2R抗体表达和尿IgG4水平；分析治疗后不同转归的IMN患者之间的血清抗PLA2R抗体阳性率及尿IgG4水平差异。结果：IMN组的血清抗PLA2R抗体阳性率及尿IgG4水平均明显高于SMN组和对照组（P＜0.05）；SMN组的尿IgG4水平明显高于对照组（P＜0.05），而血清抗PLA2R抗体阳性率与对照组差异无显著统计学意义（P＞0.05）；治疗后，IMN缓解组的血清抗PLA2R抗体阳性率明显低于未缓解组（P＜0.05），治疗后尿IgG4水平较本组治疗前及未缓解组治疗后均降低（P＜0.05），而治疗后未缓解组的尿IgG4水平较治疗前不降反升（P＜0.05）；IMN复发患者的血清抗PLA2R抗体阳性率及尿IgG4水平均明显高于无复发者（P＜0.05）。结论：IMN患者血清抗PLA2R抗体阳性率和尿IgG4水平明显升高，其变化与IMN的病情及远期结局均有关，二者联合检测有助于IMN的诊断、病情活动及预后评估。

Clinical significance of serum anti-phospholipase A2 receptor antibody and urine IgG4 detection in idiopathic membranous nephropathy

Objective: To investigate the clinical significance of detection of serum anti-phospholipase A2 receptor(PLA2R)antibody and urine IgG4 in patients with idiopathic membranous nephropathy(IMN).Methods:90 patients with membranous nephropathy(MN) were divided into IMN group(52 cases) and secondary membranous nephropathy(SMN) group(38 cases) according to the pathological type. 35 healthy people were selected in the same period as the control group. Expression of serum anti-PLA2R antibody and level of urine IgG4 were detected in the three groups. The positive rates of serum anti-PLA2R antibody and levels of urine IgG4 among the IMN patients with different outcomes after treatment were analyzed. Results: The positive rate of anti-PLA2R antibody and level of urine IgG4 in the IMN group were significantly higher than those in the SMN group and control group(P＜0.05).In the SMN group, the level of urine IgG4 was obviously higher than that in the control group(P＜0.05),while the positive rate of anti-PLA2R antibody had no significant difference with the control group(P>0.05).After treatment, the positive rate of anti-PLA2R antibody in the IMN remission group was obviously lower than that in the non-remission group(P＜0.05),and the level of urine IgG4 was significantly lower than that before treatment and that in the non-remission group(P＜0.05).After treatment,the level of urine IgG4 in the non-remission group didn′t decreased but increased(P＜0.05).The positive rate of anti-PLA2R antibody and level of urine IgG4 of the IMN patients with recurrence were obviously higher than those of the patients without recurrence(P＜0.05). Conclusion: The positive rate of anti-PLA2R antibody and level of urine IgG4 in patients with IMN are significantly enhance, and the changes are related to pathogenetic condition and long term outcome of IMN. Serum anti-PLA2R antibody and urine IgG4 detection could make a contribute to the diagnosis, disease activity and prognosis evaluation of IMN.