摘要
目的系统评价血清M型磷脂酶A2受体(M-type phospholipase A2 receptor,PLA2R)自身抗体在预测特发性膜性肾病(idiopathic membranous nephropathy,IMN)自发缓解率及治疗缓解率中的价值。方法检索PubMed、Embase、Clinical Trails、中国知网、中国生物医学文献数据库、万方、维普数据库,检索时间为从建库到2020年12月,检索内容为PLA2R抗体相关IMN的疾病缓解情况,根据诊断时PLA2R抗体阳性及阴性分组,提取二分类变量资料。用纽卡斯尔-渥太华量表评价文献质量,采用RevMan 5.3软件处理数据,计算缓解率的相对危险度(relative risk,RR)与其95%置信区间(confidence interval,CI),采用Stata 15.0软件检测发表偏倚。结果最终纳入15篇文献,均为队列研究(包括回顾性及前瞻性),共1452例IMN患者进入研究。6篇文献观察了无免疫抑制治疗IMN患者的自发缓解率,13篇文献观察了接受免疫抑制治疗IMN患者的治疗缓解率(其中4篇文献同时观察了自发缓解率及治疗缓解率)。Meta分析结果显示,IMN诊断时PLA2R抗体阳性组自发缓解率低于PLA2R抗体阴性组[RR=0.73,95%CI(0.55,0.97),P=0.03]。接受免疫抑制治疗的IMN患者,PLA2R抗体阳性组治疗缓解率低于PLA2R抗体阴性组[RR=0.81,95%CI(0.72,0.92),P=0.0009]。结论诊断时PLA2R抗体阳性的IMN自发缓解率及免疫抑制治疗的缓解率均明显低于PLA2R抗体阴性患者。对于PLA2R抗体阴性的IMN患者,因其相对较高的自发缓解率,可优先选择非免疫抑制治疗,以减少应用免疫抑制剂不良反应风险;而对于PLA2R抗体阳性的IMN患者,鉴于其较低的自发及治疗缓解率,可能需要较积极、更长程的免疫抑制治疗。
Objective To systematically review the value of autoantibodies to serum M-type phospholipase A2 receptor(PLA2 R)in predicting spontaneous and therapeutic remission rates of idiopathic membranous nephropathy(IMN).Methods PubMed,Embase,Clinical Trails,China National Knowledge Infrastructure,China Biology Medicine,Wanfang,and CQVIP databases were searched for studies on remission of IMN associated with PLA2 R antibody published from inception to December 2020.Binary variables were extracted according to PLA2 R antibody positive and negative groups.Newcastle-Ottawa Scale was used to evaluate the literature quality.Meta analyses were performed in RevMan 5.3 software,and relative risk(RR)and its 95%confidence interval(CI)were calculated.Publication bias was analyzed by Stata 15.0 software.Results A total of 15 articles were included in the meta-analysis,all of which were cohort studies(erther retrospective or prospective).A total of 1452 patients with IMN were enrolled in the study.Among them,the spontaneous remission rate of IMN patients without immunosuppressive therapy was observed in 6 articles,and the therapeutic remission rate of IMN patients receiving immunosuppressive therapy was observed in 13 articles(both spontaneous remission rate and therapeutic remission rate were observed in 4 articles).Meta-analysis results showed that the spontaneous remission rate in the PLA2 R antibody positive group was significantly lower than that in the PLA2 R antibody negative group[RR=0.73,95%CI(0.55,0.97),P=0.03].For IMN patients receiving immunosuppressive therapy,the remission rate in the PLA2 R antibody positive group was significantly lower than that in the PLA2 R antibody negative group at diagnosis[RR=0.81,95%CI(0.72,0.92),P=0.0009].Conclusions The spontaneous remission rate of IMN with PLA2 R antibody positive at diagnosis and the remission rate under the immunosuppressive therapy are significantly lower than those with PLA2 R antibody negative.For IMN patients with negative PLA2 R antibody,non-immunosuppressive therapy
作者
张珊珊
聂丽敏
姚杏
薛兰芬
ZHANG Shanshan;NIE Limin;YAO Xing;XUE Lanfen(Nephrology Department,Shijiazhuang People’s Hospital,Shijiazhuang,Hebei 050011,P.R.China)
出处
《华西医学》
CAS
2021年第1期82-90,共9页
West China Medical Journal
基金
2019年石家庄市科技计划自筹经费项目(191460523)。
关键词
特发性膜性肾病
M型磷脂酶A2受体抗体
自发缓解率
治疗缓解率
Idiopathic membranous nephropathy
M-type phospholipase A2 receptor antibody
Spontaneous remission rate
Therapeutic remission rate
