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目的探讨血清抗M型磷脂酶A2受体(PLA2R)抗体成人不典型膜性肾病(ua MN)中的诊断价值及其与蛋白尿水平相关性。方法收集北京大学深圳医院肾内科2010年1月至2015年2月住院的100例MN患者临床资料,100例MN包括特发性MN(i MN)41例,病因不明的ua MN 22例,乙型肝炎病毒相关性膜性肾病(HBV-MN)18例和膜性狼疮性肾炎(LN-MN)19例;另选取34例非MN患者作为对照。酶联免疫吸附试验(ELISA)检测血清抗PLA2R抗体滴度,并与24 h尿蛋白量、血肌酐进行相关性分析。结果 34例非MN组患者血清抗PLA2R抗体均阴性;仅1例(5.3%)LN-MN阳性;i MN组、ua MN组、HBV-MN组血清抗PLA2R抗体阳性率分别为58.5%、68.2%和72.2%,i MN组与ua MN组患者血清抗PLA2R抗体滴度与24 h尿蛋白定量呈线性相关(P<0.05)。结论血清抗PLA2R抗体阳性ua MN患者可归类于i MN,该抗体滴度可预测i MN蛋白尿变化。
Objective To investigate the diagnostic value of serum anti-M phospholipase A2 receptor (PLA2R) antibody in adult atypical membranous nephropathy (ua MN) and its correlation with proteinuria. Methods The clinical data of 100 cases of MN hospitalized in Department of Nephrology, Peking University Shenzhen Hospital from January 2010 to February 2015 were collected. 100 cases of MN included 41 cases of idiopathic MN (i MN), 22 cases of ua MN of unknown etiology, 18 cases of hepatitis-virus associated membranous nephropathy (HBV-MN) and 19 cases of membranous lupus nephritis (LN-MN). Another 34 non-MN patients were selected as the control. Serum anti-PLA2R antibody titers were detected by enzyme-linked immunosorbent assay (ELISA), and the serum levels of 24 hours urinary protein and serum creatinine were analyzed. Results The serum levels of anti-PLA2R antibody in 34 non-MN patients were all negative. Only 1 (5.3%) LN-MN was positive. The positive rates of anti-PLA2R antibodies in i MN, ua MN and HBV-MN groups were 58.5% % And 72.2% respectively. The serum anti-PLA2R titer in i MN group and ua MN group was linearly correlated with 24 h urine protein (P <0.05). Conclusions Serum anti-PLA2R antibody-positive ua MN patients can be classified as i MN, and this antibody titer can predict i MN proteinuria.