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中华肾病研究电子杂志

中华肾病研究电子杂志 ›› 2019, Vol. 08 ›› Issue (06) : 246 -252. doi: 10.3877/cma.j.issn.2095-3216.2019.06.004

所属专题： 文献；

论著

血、尿中PLA2R抗体以及THSD7A抗体在特发性膜性肾病中的临床意义
杨囡1, 王利华1,†()   
  1. 1. 030000　太原，山西医科大学第二医院　肾内科
  • 收稿日期:2019-03-14 出版日期:2019-12-28
  • 通信作者: 王利华

Clinical significance of PLA2R antibody and THSD7A antibody in serum and urine of patients with idiopathic membranous nephropathy

Nan Yang1, Lihua Wang1,†()   

  1. 1. Department of Nephrology, Second Hospital of Shanxi Medical University, Taiyuan 030000, China
  • Received:2019-03-14 Published:2019-12-28
  • Corresponding author: Lihua Wang
  • About author:
    Corresponding author: Wang Lihua, Email:
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杨囡, 王利华. 血、尿中PLA2R抗体以及THSD7A抗体在特发性膜性肾病中的临床意义[J]. 中华肾病研究电子杂志, 2019, 08(06): 246-252.

Nan Yang, Lihua Wang. Clinical significance of PLA2R antibody and THSD7A antibody in serum and urine of patients with idiopathic membranous nephropathy[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2019, 08(06): 246-252.

目的

通过检测膜性肾病(MN)患者中血清、尿中M型磷脂酶A2受体(PLA2R)抗体以及1型血小板反应蛋白7A域(THSD7A)抗体浓度，探讨其在特发性膜性肾病(IMN)中的临床意义。

方法

选取2015年7月至2017年12月在山西医科大学第二医院肾内科经过肾活检确诊为MN的患者，通过酶联免疫吸附方法(ELISA)测定血清、尿中PLA2R抗体以及THSD7A抗体浓度水平。采用SPSS 21.0软件对数据进行统计分析。

结果

经临床、病理确诊为MN的患者189例，其中IMN组165例(87.3%)。(1)IMN患者血清、尿PLA2R抗体的阳性率分别64.8%、60.0%，血清、尿THSD7A抗体的阳性率分别为8.4%、5.4%；(2)IMN患者血清、尿PLA2R抗体浓度与24 h尿蛋白定量呈正相关(P<0.05)，与血清白蛋白呈负相关(P<0.05)；(3)IMN患者中血清、尿THSD7A抗体浓度与24 h尿蛋白定量呈正相关(P<0.05)，与血清白蛋白无相关性(P>0.05)；(4)IMN患者中血清PLA2R、抗体浓度与尿PLA2R抗体浓度呈正相关(P<0.05)，血清THSD7A抗体浓度与尿THSD7A抗体浓度呈正相(P<0.05)。

结论

血清、尿中PLA2R抗体以及THSD7A抗体均可作为IMN诊断的特异性指标，相对于THSD7A抗体而言，PLA2R抗体检出率更高，且这两种抗体在血清、尿中浓度水平与临床指标存在一定的相关性。

关键词: 特发性膜性肾病, 磷脂酶A2受体, 1型血小板反应蛋白7A域
Objective

To investigate the clinical significance of M type phospholipase A2 receptor (PLA2R) antibody and thrombospondin type-1 domain-containing protein 7A (THSD7A) antibody in idiopathic membranous nephropathy (IMN) by detecting their titers in serum and urine of patients with IMN.

Methods

The patients who were diagnosed as MN by renal biopsy in the Department of Nephrology, Second Hospital of Shanxi Medical University from July 2015 to December 2017 were selected. The levels of PLA2R antibody and THSD7A antibody in serum and urine were determined by enzyme-linked immunosorbent assay (ELISA).

Results

The 189 patients were diagnosed as MN by clinical and pathological methods, including 165 patients (87.3%) in the IMN group. The positive rates of PLA2R antibody in the serum and urine of IMN patients were 64.8% and 60.0%, respectively, while the positive rates of THSD7A antibody were 8.4% and 5.4%, respectively. The serum and urine PLA2R antibody concentrations of IMN patients were positively correlated with the 24 h urinary protein quantification (P<0.05), and negatively correlated with serum albumin(P<0.05). In the IMN patients, the serum and urine THSD7A antibody concentrations were positively correlated with the 24 h urine protein quantification(P<0.05), but not with serum albumin(P>0.05). The PLA2R antibody concentration in the serum was positively correlated with that in the urine of the IMN patients(P<0.05), while the THSD7A antibody concentration in the serum was positively correlated with that in the urine of the IMN patients(P<0.05).

Conclusion

Both PLA2R antibody and THSD7A antibody in the serum and urine were shown to be potential specific markers for the diagnosis of IMN. Compared with the THSD7A antibody, the PLA2R antibody detection rate was higher, and the concentrations of these two antibodies in the serum and urine had a certain correlation with the clinical indicators.

Key words: Idiopathic membranous nephropathy, Phospholipase A2 receptor, Thrombospondin type-1 domain-containing protein 7A
表1 不同膜性肾病组临床指标比较[±s，例数(%)]
组别 例数 性别(男/女) 年龄(岁) 尿蛋白定量(g/d) 血清白蛋白(g/L) 血清肌酐(μmol/L)
IMN 165 114/51 51.17±12.02 3.18±2.25 24.83±6.39 69.41±17.29
UAMN 15 6/9 49.47±10.49 2.86±1.70 24.47±6.85 66.07±16.31
MLN 9 0/9 48.33±12.13 2.34±2.24 21.71±5.57 98.22±49.34ab
χ2/F值 ? 21.455 0.360 0.739 1.020 9.542
P值 ? <0.001 0.698 0.479 0.363 <0.001
组别 例数 eGFR[ml/(min·1.73 m2)] 尿酸(μmol/L) 总胆固醇(mmol/L) 胱抑素C (mg/L)
IMN 165 104.44±16.77 364.91±91.68 7.35±2.27 0.64±0.25
UAMN 15 105.63±23.25 294.60±52.56a 7.07±1.82 0.55±0.15
MLN 9 78.33±42.22ab 462.44±164.45ab 5.99±2.75 1.25±0.60ab
χ2/F值 ? 8.085 9.086 1.612 23.857
P值 ? <0.001 <0.001 0.202 <0.001
表2 不同膜性肾病组PLA2R抗体阳性率比较[例(%)]
组别 例数 血清PLA2R抗体 尿PLA2R抗体
阳性 阴性 阳性 阴性
IMN 165 107(64.8) 58(35.2) 99(60.0) 66(40.0)
UAMN 15 5(33.3) 10(66.7) 4(26.7) 11(73.3)
MLN 9 0(0.0) 9(100.0) 0(0.0) 9(100.0)
χ2值 ? 19.402 17.479
P值 ? <0.001 <0.001
图1 IMN患者血清PLA2R浓度与24 h尿蛋白定量、血清白蛋白相关性
图2 IMN患者尿PLA2R抗体浓度与24 h尿蛋白定量、白蛋白相关性
表3 IMN患者PLA2R抗体浓度与24 h尿蛋白定量、血清白蛋白相关性分析
指标 血清PLA2R抗体浓度(μg/L) 尿PLA2R抗体浓度(μg/L)
r P r P
尿蛋白定量(g/d) 0.293 0.002 0.288 0.004
血清白蛋白(g/L) －0.260 0.007 －0.212 0.035
图3 IMN患者血THSD7A抗体浓度与24 h尿蛋白定量相关性
图4 IMN患者尿THSD7A抗体浓度与24 h尿蛋白定量相关性
表4 IMN患者THSD7A浓度与24 h尿蛋白定量、白蛋白相关性分析
指标 血清THSD7A抗体浓度(μg/L) 尿THSD7A抗体浓度(μg/L)
r P r P
尿蛋白定量(g/d) 0.670 0.009 0.667 0.049
血清白蛋白(g/L) －0.233 0.422 －0.183 0.637
图5 IMN患者血清PLA2R、THSD7A抗体浓度与尿液PLA2R、THSD7A抗体浓度相关性
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