乙型肝炎病毒相关膜性肾病患者抗血清磷脂酶A2受体-IgG特点及其相关因素的临床研究

目的研究乙型肝炎病毒相关膜性肾病(HBV-MN)患者血清抗磷脂酶A2受体(PLA2R)-IgG阳性率，分析与PLA2R-IgG滴度相关的因素。 方法本研究纳入经肾穿刺活检确诊的HBV-MN患者108例，检测血清PLA2R－IgG滴度、肌酐、白蛋白和24 h尿蛋白定量等，计算肾小球滤过率，分别统计患者肾活检组织中PLA2R及免疫荧光IgG、C3、C1q及IgG亚型阳性率，分析年龄、性别、蛋白尿与血清中和肾活检组织中PLA2R-IgG检测结果的关系。 结果108例HBV-MN患者中，血清PLA2R-IgG阳性率为37%，肾组织PLA2R阳性率54.6%，血清PLA2R-IgG的阳性率和滴度与年龄、性别无统计学相关性(P>0.05)，与尿蛋白水平相关(χ²＝9.159，P＝0.010；χ²＝11.327，P＝0.004)；尿蛋白>3.5 g/d组患者PLA2R－IgG阳性率显著高于尿蛋白<1g/d及1～3.5 g/d组(Z＝2.863，P＝0.012和Z＝2.356，P＝0.049)。 结论HBV-MN患者中PLA2R-IgG阳性率较高，阳性率及滴度均与蛋白尿水平相关，尿蛋白越多，阳性率和滴度也随之升高。

Characteristics of serum anti-phospholipase A2 receptor-IgG and its related factors in patients with hepatitis B virus-associated membranous nephropathy

ObjectiveTo study the positive rate of serum anti-phospholipase A2 receptor (PLA2R)-IgG in patients with hepatitis B virus-associated membranous nephropathy (HBV-MN), and to analyze the factors related to anti-PLA2R-IgG titer. MethodsIn this study, 108 patients with HBV-MN diagnosed by renal biopsy were enrolled. The titers of serum PLA2R-IgG, serum creatinine, and serum albumin, as well as 24 h urine protein were measured. The glomerular filtration rate was calculated. The positive rates of PLA2R expression and the immunofluorescence of IgG, C3, and C1q besides IgG subtypes in the renal biopsy tissues were counted. And the relationships between age, gender, or proteinuria and anti-PLA2R-IgG detection results from serum and renal biopsies were analyzed. ResultsAmong the 108 patients with HBV-MN, the positive rate of serum anti-PLA2R-IgG was 37%, and the positive rate of PLA2R in the renal tissues was 54.6%. The positive rate and titer of serum anti-PLA2R-IgG were not statistically correlated with age and gender (P>0.05), but were correlated with the urinary protein levels (χ²=9.159, P=0.010; χ²=11.327, P=0.004). patients with urinary protein>3.5 g/d have significantly higher positive rate than patients with urinary protein <1 g/d and 1-3.5 g/d group (Z=2.863, P=0.012 and Z=2.356, P=0.049). ConclusionThe positive rate of anti-PLA2R-IgG was high in the HBV-MN patients, and its positive rate and titer were associated with the proteinuria level. The higher proteinuria level, the higher positive rate and titer of anti-PLA2R-IgG.