M型磷脂酶A2受体及其抗体在乙肝病毒#br# 相关性膜性肾病中的临床意义

目的：研究M型磷脂酶A2受体(phospholipase A2 receptor，PLA2R)在乙肝病毒相关性膜性肾病(hepatitis B virus-associated membranous nephropathy，HBV-MN)患者血液及肾组织中的表达情况，并探讨肾组织PLA2R阳性表达在乙型肝炎相关性肾小球肾炎(hepatitis B virus associated glomerulone nephritis，HBV-GN)患者中的临床和病理特点。 方法： 选取经肾活检确诊的49例HBV-MN患者。检测血清抗PLA2R抗体以及肾组织PLA2R的表达，将患者分为肾组织PLA2R表达阳性组和阴性组，比较两组间临床指标、病理改变、血抗PLA2R抗体表达水平的差异。结果：17例患者存在肾组织PLA2R阳性表达，其中10例患者血清抗PLA2R抗体阳性。肾组织阳性组较阴性组24 h尿蛋白水平升高，血白蛋白水平下降，血清HbsAg阳性比例更高(70.5%)，肾组织HbsAg表达比例更高(71%)。结论：肾组织PLA2R以及血清抗PLA2R抗体在HBV-MN患者中有一定表达，其表达可能与HBV-MN患者血清以及肾组织中HbsAg沉积有关。肾组织PLA2R阳性患者肾小球慢性损伤可能相对更重。

Role of M-type phospholipase A2 receptor and its antibody in hepatitis B virus-associated membranous nephropathy

Objective: To examine levels of M-type phospholipase A2 receptor (PLA2R) and its antibody in the patients with hepatitis B virus-associated membranous nephropathy (HBV-MN), and to explore the correlation of PLA2R with laboratory parameters and pathological characteristics. Methods: A total of 49 adult patients with biopsy-proved HBV-MN were enrolled in this study. Levels of anti-PLA2R antibody in serum and PLA2R in renal tissue were detected. Patients were assigned into two groups: a positive PLA2R group and a negative PLA2R group. Differences in laboratory parameters and pathological characteristics were compared between the two groups. Results: Of 49 patients with HBV-MN, 17 had positive PLA2R expression in renal tissues. In the positive PLA2R group, 10 patients were positive for serum anti-PLA2R antibody. Patients with positive PLA2R expression in renal tissues showed higher levels of 24 hour urinary protein (4.6±3.9) g/d], serum HbsAg (70.5%) and renal HbsAg expression (71%), while lower level of serum albumin (24.1±7.5) g/L] than those of the negative group. Conclusion: PLA2R is expressed in the renal tissues and serum anti-PLA2R antibody can be detected in some HBV-MN patients. Positive PLA2R expression in renal tissue might be related to HbsAg deposition in serum and renal tissues. Patients with positive PLA2R expression in renal tissue have more severe glomerular sclerosis.