成人特发性膜性肾病血清抗M型磷脂酶A2受体抗体与病情的相关性研究

目的  通过研究成人特发性膜性肾病（IMN）血清抗M型磷脂酶A2受体（PLA2R）抗体的阳性滴度与其他实验室指标的相关性，进一步探讨抗PLA2R抗体对IMN诊断及病情评估的作用。方法  选取B超引导下肾穿刺活检证实为IMN患者55例，追踪观察6个月，同时选取15例健康体检者为对照组，应用酶联免疫吸附法（ELISA）检测血清抗PLA2R抗体，同时对IMN患者24 h尿蛋白定量、血清总蛋白、血清白蛋白、血清总胆固醇、血清肌酐进行检测。结果  经过3和6个月治疗后，血清抗PLA2R抗体较治疗前降低（P <0.05）。55例IMN患者治疗前血清抗PLA2R抗体阳性患者47例，阳性率为85.45%；治疗3个月后血清抗PLA2R抗体阳性患者36例，阳性率为65.45%，治疗6个月后血清抗PLA2R抗体阳性患者25例，阳性率45.45%。且治疗前血清抗PLA2R抗体滴度与尿蛋白定量呈正相关，与血清白蛋白、总蛋白呈负相关；治疗6个月后血清抗PLA2R抗体滴度与尿蛋白定量呈正相关，与血清白蛋白、总蛋白呈负相关。结论  血清抗PLA2R抗体可作为IMN血清学诊断的指标之一，血清抗PLA2R抗体滴度下降与尿蛋白的减少密切相关，与疾病预后、病情转归也可能相关。

Correlation between serum anti-PLA2R antibody and adult idiopathic membranous nephropathy

Objective To investigate the relationship between the positive titer of serum anti- phospho-lipase A2 receptor (PLA2R) antibody and other laboratory indexes in adult patients with idiopathic membranous nephropathy (IMN), and to explore the roles of anti-PLA2R antibody in the diagnosis of IMN and the evaluation of the disease severity. Methods Fifty-five IMN patients were selected, and 15 cases of healthy persons were selected as the control group. Serum anti-PLA2R antibody was detected by ELISA. And 24-h urinary protein, serum total protein, serum total cholesterol and serum creatinine were detected in the IMN patients. Results After 3 months and 6 months, the serum anti-PLA2R antibody was significantly lower than that before treatment (P < 0.05). Before treatment 47 of 55 IMN patients were anti-PLA2R antibody positive, the positive rate was 85.45%; 3 months after the treatment there were 36 patients with positive anti-PLA2R antibody, the positive rate was 65.45%; 6 months after treatment, anti-PLA2R antibody positive rate was 45.45% (25/55). The serum anti-PLA2R antibody titer was positively correlated with urinary protein, but was negatively correlated with serum albumin and total protein before treatment and 6 months after treatment. Conclusions Serum anti-PLA2R antibody can be used as one of the serum indexes of IMN, and serum anti-PLA2R antibody titer is closely related to urine protein, which may be closely related to the prognosis and outcome of the disease.