Pang Lu, Zhang Ai-Min, Li Hai-Xia, Du Jia-Lin, Jiao Li-Li, Duan Nan, Liu Yi, Yu Dan
Department of Clinical Laboratory, Peking University First Hospital, Beijing Department of Clinical Laboratory, Tianjin Nankai Hospital, Tianjin, The People's Republic of China.
Medicine (Baltimore). 2017 Jun;96(24):e7218. doi: 10.1097/MD.0000000000007218.
M-type phospholipase A2 receptor (PLA2R) is the major target antigen in primary membranous nephropathy (PMN). Previous studies have evaluated the diagnostic value of serum anti-PLA2R antibody. However, the correlation of serum anti-PLA2R antibody and glomerular PLA2R deposition, and their association with clinical characteristics need to be further evaluated.A total of 136 patients were involved as inception group because serum anti-PLA2R antibody and glomerular PLA2R antigen were simultaneously measured. We examined serum anti-PLA2R antibody by ELISA and glomerular PLA2R deposition by immunofluorescence assay.Positive serum anti-PLA2R antibody and glomerular PLA2R deposition were seen in 58.8% (80/136) and 95.6% (130/136) patients, respectively (P < .001). Proteinuria, serum total protein, serum albumin, serum creatinine, and estimated glomerular filtration rate (eGFR) had significant differences between patients with serum anti-PLA2R antibody and those without. Serum anti-PLA2R antibody levels were correlated with serum albumin, serum creatinine, eGFR, and proteinuria. Glomerular PLA2R deposition intensities were weakly correlated with proteinuria. Unexpectedly, there was a positive correlation rather than a negative correlation between glomerular PLA2R deposition intensity and eGFR.In conclusion, serum anti-PLA2R antibody is more closely correlated with disease activity and renal function than glomerular PLA2R deposition.
M型磷脂酶A2受体(PLA2R)是原发性膜性肾病(PMN)的主要靶抗原。既往研究评估了血清抗PLA2R抗体的诊断价值。然而,血清抗PLA2R抗体与肾小球PLA2R沉积的相关性及其与临床特征的关联尚需进一步评估。
共有136例患者作为起始队列纳入研究,因为同时检测了血清抗PLA2R抗体和肾小球PLA2R抗原。我们采用酶联免疫吸附测定(ELISA)检测血清抗PLA2R抗体,采用免疫荧光法检测肾小球PLA2R沉积。
血清抗PLA2R抗体阳性和肾小球PLA2R沉积阳性的患者分别为58.8%(80/136)和95.6%(130/136)(P<0.001)。血清抗PLA2R抗体阳性和阴性的患者在蛋白尿、血清总蛋白、血清白蛋白、血清肌酐和估算肾小球滤过率(eGFR)方面存在显著差异。血清抗PLA2R抗体水平与血清白蛋白、血清肌酐、eGFR和蛋白尿相关。肾小球PLA2R沉积强度与蛋白尿呈弱相关。出乎意料的是,肾小球PLA2R沉积强度与eGFR呈正相关而非负相关。
总之,血清抗PLA2R抗体比肾小球PLA2R沉积与疾病活动度和肾功能的相关性更强。