摘要
目的 单中心回顾性分析近16年病理诊断为特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者的分布特点及变化趋势,评估血清抗磷脂酶A2受体抗体(PLA2R-Ab)对IMN的诊断和鉴别诊断价值,分析抗体滴度与疾病活动的相关性.方法 (1)收集2000年1月至2015年12月于本院行肾穿刺活检并明确诊断为原发性肾小球肾炎(primary glomerulonephritis,PGN)者6996例,其中IMN 1567例;收集患者肾穿刺活检时的一般资料;(2)选取2015年6月至2015年12月同时行肾穿刺活检及血清PLA2R-Ab检测者433例,收集患者一般信息及实验室检查结果;在此期间对多次随访的患者记录其随访时间、治疗方案及实验室检查结果.结果 (1) IMN占PGN 22.4％,其中40岁以上IMN患者占60％以上.(2)在未接受免疫抑制治疗的患者中PLA2R-Ab诊断IMN的敏感性为58.1％ (95％CI 47.0％～68.5％),特异性98.6％(95％CI 95.6％～99.6％);PLA2R-Ab检出率受免疫抑制治疗影响.(3)PLA2R-Ab滴度与尿蛋白量(r=-0.017,P=0.887)、血浆白蛋白(r=-0.072,P=0.549)、尿红细胞计数(r=-0.030,P=0.802)均未显示相关关系;PLA2R-Ab阳性与阴性组I-Ⅱ期MN患者所占比例相当(P＞0.05);13例PLA2R-Ab阳性IMN患者接受免疫抑制治疗后,尿蛋白及血浆白蛋白改善(P＜0.05),抗体滴度下降,差异有统计学意义(P＜0.05).结论 IMN发病率呈现逐年上升趋势,发病年龄以中老年人群为主.血清PLA2R-Ab与IMN发病有显著相关性,与病理分期无对应关系,动态监测个体PLA2R-Ab滴度变化或可以评估临床疗效.
Objective To conduct a single-center retrospective analysis on the distribution characteristics and prevalence of idiopathic membranous nephropathy (IMN) patients diagnosed with pathology for the past 16 years,to investigate diagnostic and differential diagnostic value of serum antiphospholipase A2 receptor antibodies (PLA2R-Ab),and to evaluate the correlation between PLA2R-Ab and clinical disease activity.Methods (1) 6996 biopsy-proven primary glomerular nephropathy (PGN) patients,including 1567 IMN cases,admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2000 to December 2015 were involved.Demographics and pathological type were gathered from all patients.(2) 433 cases receiving renal biopsy and testing PLA2R-Ab from June 2015 to December 2015 were involved,with their clinical and laboratorial data being collected.During the period patients' follow-up time,therapeutic schedule and laboratory results were recorded.Results (1) IMN accounted for 22.4％ of primary glomerular disease,and patients above 40 years old accounted for more than 60％ of the IMN.(2) The sensitivity and specificity of serological PLA2R-Ab were 58.1％(95％CI 47.0％-68.5％) and 98.6％(95％CI 95.6％-99.6％) respectively.PLA2R-Ab positive rate was affected by immunosuppression therapy.(3) The PLA2R-Ab titers wasn't correlated with 24-hour urinary protein (r=-0.017,P=0.887),serum albumin (r=-0.072,P=0.549) and urinary red blood cell count (r=-0.030,P=0.802).There was no difference between PLA2R-Ab positive positive and PLA2R-Ab negative on proportion of IMN pathological stage Ⅰ-Ⅱ (P ＞ 0.05).Thirteen cases of patients with PLA2R-Ab positive were all prescribed glucocorticoid combined with immunosuppressant.After (2.21± 1.09) months,the decrease of PLA2R-Ab titers was in accordance with 24-hour urinary protein quantity descending and serum albumin ascending (P ＜ 0.05).Condusions The incidence of IMN increase year by year,especially in the mid-aged and the elderly.Serum PLA2R-Ab correlates not with
出处
《中华肾脏病杂志》
CSCD
北大核心
2016年第9期647-652,共6页
Chinese Journal of Nephrology
