摘要
目的探讨血清抗M型磷脂酶A2受体抗体（M-type phospholipase A2receptor antibody,anti-PLA2R）对特发性膜性肾病（idiopathic membranous nephropathy,IMN）的诊断价值及与尿蛋白的相关性,确定其对预测IMN的诊断界值。方法纳入经肾穿刺活检证实的IMN、狼疮性肾炎（lupus nephritis,LN）、乙型肝炎病毒相关性肾炎（hepatitis B virus associated nephropathy,HBV-GN）、IgA肾病（IgA nephropathy,IgAN）患者及健康对照者。检测各组患者尿白蛋白肌酐比值（urinary albumincreatinine ratio,UAlb/Cr）、24小时尿蛋白定量（24 hour urinary protein quantitative,24hPro）、血肌酐（serum creatinine,Scr）、血尿素氮（blood urea nitrogen,BUN）、血白蛋白（serum albumin,Alb）。酶联免疫吸附法检测外周血anti-PLA2R,比较各组患者血清anti-PLA2R水平。对各组患者血清anti-PLA2R与UAlb/Cr及24hPro做两因素相关性分析。对血清anti-PLA2R做ROC曲线,确定anti-PLA2R对IMN的诊断界值。结果 IMN组患者血清anti-PLA2R水平[（23.66±4.06）μg/L明显高于LN组[（17.92±3.13）μg/L、HBV-GN组[（14.33±4.43）μg/L、IgAN组[（13.68±1.81）μg/L及健康对照组[（11.65±3.08）μg/L,差异均有统计学意义（均P〈0.05）。血清anti-PLA2R与IMN患者UAlb/Cr（r=0.795,P〈0.001）及24hPro（r=0.531,P=0.016）成显著正相关。以肾组织病理诊断为金标准,绘制血清anti-PLA2R诊断IMN的ROC曲线,发现曲线下面积为0.938（95%CI：0.881-0.996）,根据敏感性和特异性之和最大的方法确定血清antiPLA2R临床诊断IMN的界值为19.07μgl,敏感性为95.0%,特异性为79.1%。结论血清anti-PLA2R与IMN患者尿蛋白成正相关,可能是诊断及监测IMN患者病情变化的新型血清标记物。
Objective To investigate the diagnostic value of serum M-type phospholipase A2 receptor antibody（ anti-PLA2R） in patients with idiopathic membranous nephropathy（ IMN） and the correlation between antiPLA2 R and urine protein. Methods A total of 76 patients with renal biopsy-proved glomerular disease were enrolled in this study,including 20 cases with IMN,20 cases with lupus nephritis（ LN）,16 cases with hepatitis B virus associated nephropathy（ HBV-GN）,and 20 cases with IgA nephropathy（ IgAN）. Eight healthy controls were also enrolled. The parameters of urinary albumincreatinine ratio（ UAlb/Cr）,24 hour urinary protein secretion level（ 24 hPro）,serum creatinine（ Scr）,blood urea nitrogen（ BUN） and serumalbumin（ Alb） were measured. The serum anti-PLA2 R levels were detected by a ELISA kit. The levels of serum anti-PLA2 R were compared among the five groups,and the correlation between serum anti-PLA2 R with UAlb/Cr and 24 hPro were analyzed. ROC curve was plotted to determine the diagnostic sector of serum anti-PLA2 R in predicting IMN. Results The levels of serum anti-PLA2 R in patients with IMN [（ 23. 66 ±4. 06） μg/L] were higher than the LN group [（ 17. 92 ± 3. 13） μg/L ], HBV-GN group [（ 14. 33 ±4. 43） μg/L],IgA N group [（ 13. 68 ± 1. 81） μg/L],and the control group [（ 11. 65 ± 3. 08） μg/L].Correlation analysis found that the serum anti-PLA2 R levels are positively correlated with UAlb/Cr（ r =0. 795,P〈 0. 001） and 24 hPro（ r = 0. 531,P = 0. 016） in patients with IMN. ROC curve showed that the area under the curve was 0. 938（ 95% CI： 0. 881- 0. 996）. The clinical diagnostic sector of anti-PLA2 R in diagnosing IMN was 19. 07 μg/l sensitivity 95. 0%,specificity 79. 1%）. Conclusions Serum antiPLA2 R levels are positively correlated with urine protein in patients with IMN,and it may be a novel serum biomarker for predicting IMN with high sensitivity and specificity.
出处
《中华临床免疫和变态反应杂志》
2016年第1期15-20,共6页
Chinese Journal of Allergy & Clinical Immunology
基金
浙江省医学会临床科研基金(2011ZYC-A86)
关键词
抗M型磷脂酶A_2受体抗体
特发性膜性肾病
诊断价值
M-type phospholipase A_2 receptor antibody
idiopathic membranous nephropathy
diagnostic value
作者简介
通信作者电话：0575-88229262，电子邮件：qiujieshanww@126．com
