摘要： 目的 探讨抗磷脂酶A2受体抗体（PLA2R-Ab）与原发性膜性肾病（PMN）患者临床特征和预后的相关性。方法 本研究共纳入经肾穿刺活检确诊为PMN的患者137例。根据血清PLA2R-Ab滴度分为抗体阴性组（52例）和抗体阳性组（85例），2组的临床基线特征、临床缓解率及治疗前后的24 h尿蛋白、白蛋白（ALB）、血肌酐比较采用t检验或Mann-Whitney检验，并进行PLA2R-Ab与各临床指标间相关性分析。结果 PLA2R-Ab阳性组患者的24 h尿蛋白定量较高（P < 0.01），总蛋白（TP）和ALB较低（P < 0.01），缓解率较低（P < 0.05）。完全缓解和部分缓解患者的蛋白尿均显著下降（P < 0.01），ALB显著上升（P < 0.01），肾功能维持稳定水平，PLA2R-Ab水平随疾病的缓解显著下降（P < 0.01）。PLA2R-Ab与TP、ALB呈负相关（P < 0.01），与C4呈正相关（P < 0.01）。结论 血清PLA2R-Ab阳性的PMN患者临床表现较重，临床缓解率较低；PLA2R-Ab水平的变化与临床缓解情况密切相关，监测PLA2R-Ab变化对PMN的诊治及预后评估有重要价值。

抗磷脂酶A2受体抗体与原发性膜性肾病的临床特征和预后的相关性

王媛媛, 周华

中国医科大学附属盛京医院肾脏内科, 沈阳 110004

收稿日期:2021-09-02出版日期:2022-02-28发布日期:2022-01-05
通讯作者:周华E-mail:huazhou_cmu@163.com
作者简介:王媛媛(1991-),女,医师,硕士.
基金资助:国家自然科学基金（81770698）；辽宁省重点研发指导计划（2019JH8/10300009）；辽宁省高等学校攀登****（2013222）


关键词: 原发性膜性肾病, 抗磷脂酶A2受体抗体, 临床特征, 预后
Abstract: Objective To investigate the correlation between anti-phospholipase A2 receptor antibody (PLA2R-Ab) levels and clinical features and the prognosis of patients with primary membranous nephropathy (PMN). Methods A total of 137 patients with biopsy-proven PMN were included and further classified into antibody-negative (52 cases) and antibody-positive (85 cases) groups. The clinical baseline features, clinical remission rates, and the changes in 24-h urine protein, albumin (ALB), and serum creatinine before and after treatment were compared between the two groups using t test and Mann-Whitney test. The correlation analyses of PLA2R-Ab with clinical baseline features were performed. Results The PLA2R-Ab-positive group demonstrated a higher 24-h urine protein (P < 0.01), lower total albumin (TP) and ALB levels (P < 0.01), and significantly lower remission rate (P < 0.05) than the PLA2R-Ab-negative group. Proteinuria in patients in complete remission and partial remission decreased significantly (P < 0.01), ALB increased significantly (P < 0.01), and renal function remained stable. PLA2R-Ab levels decreased significantly with remission of disease (P < 0.01). PLA2R-Ab was negatively correlated with TP and ALB (P < 0.01) and positively correlated with C4 (P < 0.01). Conclusion Compared with the PLA2R-negative group, the PLA2R-positive group had severe clinical manifestations and a lower clinical treatment remission rate. The change in PLA2R antibody level was closely associated with clinical remission, and monitoring PLA2R-antibody is of great value for the diagnosis, treatment, and prognosis evaluation of PMN.
Key words: primary membranous nephropathy, anti-PLA2R antibody, clinical features, prognosis
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