目的:观察特发性膜性肾病(idiopathic membranous nephropathy,IMN)血清抗磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体表达情况,探讨血清抗PLA2R抗体和免疫治疗疗效的关系。方法:选取经肾活检确诊为IMN的患者60例,用间接免疫荧光法检测血清抗PLA2R抗体,免疫组织化学染色后观察肾组织PLA2R的表达。根据血清抗PLA2R抗体检测结果,将患者分为血清抗PLA2R抗体阳性组44例,血清抗PLA2R抗体阴性组16例,均给予激素联合环磷酰胺方案治疗,疗程12个月。观察治疗前后24h尿蛋白、血清白蛋白、血肌酐、估计肾小球滤过率(glomerular filtration rate,eGFR)变化以及血清抗PLA2R抗体转阴情况。结果:(1)60例IMN患者在基线时检测血清抗PLA2R抗体阳性为44例,阳性率73.3%。基线时血清抗PLA2R抗体阳性患者肾组织PLA2R表达也呈阳性。(2)抗PLA2R抗体阴性组患者24h尿蛋白、血白蛋白恢复情况优于抗PLA2R抗体阳性组(P<0.05)。(3)治疗6个月后抗PLA2R抗体阳性和阴性组总缓解率分别为47.7%和93.9%,治疗12个月总缓解率分别为56.8%和100%。结论:血清抗PLA2R抗体是IMN的特异性生物标志物。血清抗PLA2R抗体阳性的患者免疫治疗效果差。IMN患者检测血清抗PLA2R抗体有助于判断病情,对于治疗策略的选择和病情的监测具有重要意义。
Objective :To observe the expression of serum anti-phospholipase A 2 receptor (PLA 2R) antibodies in idiopathic membranous nephropathy (IMN),and also to explore the relationship between serum anti-PLA 2R antibodies and immunotherapy.Methods :Serum anti-PLA 2R antibodies and immunohistochemical staining were used to detect the expression levels of anti-PLA 2R antibodies in the renal tissue of 60 IMN patients.According to the detection results of serum anti-PLA 2R antibodies,they were divided into the positive group (44 cases) and the negative group (16 cases).The two groups were all treated with hormone combined with cyclophosphamide for a treatment course of 12 months.The changes in 24-h urinary protein,serum albumin, serum creatinine and glomerular filtration rate (eGFR) were observed before and after the treatment.And negative turning of serum anti-PLA 2R antibodies before and after the treatment was also observed.Results :(1) Of the 60 patients with IMN,there were 44 patients with positive serum anti-PLA 2R antibodies at baseline,with a positive rate of 73.3%.The expression of anti-PLA 2R antibodies in the renal tissue of the patients with positive serum anti-PLA 2R antibodies was also positive at baseline.(2) 24-h urinary protein and serum albumin recovery of the patients in the negative group were better than those in the positive group ( P <0.05).(3)The total remission rates of the anti-PLA 2R antibodies in the positive group and the negative group were 47.7% and 93.9% respectively after 6 months of the treatment,and total remission rates of the 2 groups were 56.8% and 100% respectively after 12 months of the treatment.Conclusion :Serum anti-PLA 2R antibodies is a specific biomarker of IMN.Patients with positive serum anti-PLA 2R antibodies show poor immunotherapy effect.Detection of serum anti-PLA 2R antibodies in the IMN patients is helpful to judge the illness condition of the patient,and is of great importance for the choice of treatment strategy and monitoring of the disease.
Pharmaceutical Care and Research
idiopathic membranous nephropathy
serum anti-phospholipase A 2 receptor antibody