血清PLA2R抗体及THSD7A抗体检测在特发性膜性肾病中的临床意义

doi:10.3969/j.issn.1004-583X.2018.10.010

摘要/Abstract

摘要： 目的通过检测特发性膜性肾病（Idiopathic membranous nephropathy，IMN）患者血清PLA2R及THSD7A抗体水平，探讨二者对IMN诊断及病情评估的意义。方法选取2016年9月至2017年12月在河北医科大学第三医院肾内科，行肾穿刺活检诊断IMN患者114例，V型狼疮性肾炎7例、IgA肾病16例作为非IMN组。采用ELISA测定各组血清PLA2R抗体及THSD7A抗体水平，并分析二者与临床指标的关系。结果 ①IMN组血清PLA2R抗体阳性率57.0%（65/114），非IMN组均阴性，差异有统计学意义（P<0.05）。IMN组血清THSD7A抗体阳性率9.6%（11/114），非IMN均阴性，差异有统计学意义（P<0.05）。IMN组双抗体阳性率为4.4%（5/114）。②IMN组双抗体阳性患者24小时尿蛋白定量9.4（4.9~14.0 ） g/d，血白蛋白（21.2±3.7） g/L；PLA2R抗体阳性患者24小时尿蛋白定量［4.9(0.9~14.2) g/d］，血白蛋白（24.4±5.6） g/L；THSD7A抗体阳性患者24小时尿蛋白定量7.1（2.1~14.0） g/d，血白蛋白（25.5±6.6） g/L；双抗体阳性与PLA2R抗体阳性患者比较：24小时尿蛋白定量及血白蛋白差异均有统计学意义（P＜0.05）；与THSD7A抗体阳性患者比较：24小时尿蛋白定量差异无统计学意义（P＞0.05），血白蛋白差异有统计学意义（P＜0.05）。③IMN组PLA2R抗体水平与24小时尿蛋白呈正相关（r=0.318，P=0.001），与血白蛋白呈负相关（r=-0.207，P=0.027）。结论血清PLA2R抗体及THSD7A抗体是IMN的特异性指标；PLA2R抗体可评估IMN患者病情；双抗体阳性患者24小时尿蛋白较高，血白蛋白较低，临床表现较重；但THSD7A抗体能否评估IMN病情有待进一步研究。

关键词: 肾小球肾炎, , 膜性, M型磷脂酶A2受体抗体, 1型血小板反应蛋白7A域

Abstract: Objective To explore the significance of both the IMN diagnosis and the evaluation of the disease by detecting the serum PLA2R and THSD7A antibody levels in IMN patients. Methods A total of 137 patients who were diagnosed with renal biopsy in the third hospital of Hebei medical university from September 2016 to December 2017 were selected. Among them, 114 patients with IMN were treated as experimental group, and the rest patients, including (7 cases of Vtype lupus nephritis and 16 cases of IgA nephropathy) as control group. The serum PLA2R and THSD7A antibody titer were determined by enzymelinked immuno sorbent assay (ELISA), then the relationship between them and clinical indicators were analyzed. Results ①The positive rate of serum PLA2R antibody in IMN patients is 57.0% (65/114). Vtype lupus nephritis and IgA nephropathy are negtive; the difference has been statistically significant (P＜0.05). The positive rate of serum THSD7A antibody in IMN patients is 9.6% (11/114), Vtype with lupus nephritis and IgA nephropathy THSD7A antibody are negtive, the difference is statistically significant. The double positive rate in IMN group is 4.4% (5/114). ② In the IMN group, 24 h urine protein is quantitatively 9.4(4.9~14.0) g/d and blood albumin (21.2±3.7) g/L. PLA2R antibody positive 24 h urine protein quantification ［4.9(0.914.2)］ g/d, blood albumin (24.4±5.6) g/L; The serum albumin (25.5±6.6) g/L is found in patients with positive THSD7A antibody 7.1(2.1~14.0) g/d. The results showed that there are statistically significant differences between the serum albumin and the serum albumin (P<0.05), so are the differences in blood albumin (P<0.05); while the quantitative difference of 24 h urine protein in patients with positive THSD7A antibody (P＞0.05) are of no statistical difference. ③There is a positive correlation between PLA2R antibody and 24 h urine protein (r=0.318,P=0.001), which is negatively correlated with serum albumin level (r=-0.207, P=0.027).Conclusion PLA2R and THSD7A antibody are specific indicators for the diagnosis of IMN. PLA2R antibody can assess the patient's condition; the urinary protein of the patients is high while their albumin is low, with double antibody being positive; However, whether THSD7A can assess the patient's condition and whether the combination can better predict the patient's condition remains to be further studied.

Key words: glomerulonephritis, , membranous; , Mtype phospholipase A2 receptor； Thrombospondin type1 domaincontaining 7A

张文贤，田梦蕾，赵松，迟雁青，刘茂东，李英. 血清PLA2R抗体及THSD7A抗体检测在特发性膜性肾病中的临床意义[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2018.10.010.

Zhang Wenxian, Tian Menglei, Zhao Song, Chi Yanqing, Liu Maodong, Li Ying. The clinical significance of serum antibodies of PLA2R and THSD7A in idiopathic membranous nephropathy[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2018.10.010.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2018.10.010

https://huicui.hebmu.edu.cn/CN/Y2018/V33/I10/873

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血清PLA2R抗体及THSD7A抗体检测在特发性膜性肾病中的临床意义

The clinical significance of serum antibodies of PLA2R and THSD7A in idiopathic membranous nephropathy

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