Garcia-Vives E, Solé C, Moliné T, Alvarez-Rios A M, Vidal M, Agraz I, Ordi-Ros J, Cortés-Hernández J
1 Department of Medicine, Systemic Autoimmune Diseases Unit, Hospital Universitari Vall d'Hebrón, Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain.
2 Department of Renal Pathology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, Spain.
Lupus. 2019 Mar;28(3):396-405. doi: 10.1177/0961203319828521. Epub 2019 Feb 13.
Antibodies to M-type phospholipase A2 receptor (a-PLAR) have been identified in most patients with idiopathic membranous nephropathy, but the prevalence in membranous lupus nephritis (MLN) is still unclear. The objective of this study was to assess the prevalence of a-PLAR antibodies in a large cohort of patients with lupus nephritis.
a-PLAR antibodies were measured by ELISA in serum from patients with systemic lupus erythematosus ( n = 190), of whom 37 had a biopsy-proven MLN. Positive samples were confirmed by commercial ELISA kit, Western blot and immunohistochemistry in renal tissue.
A total of 10 from 190 patients (5.3%) with systemic lupus erythematosus had circulating a-PLAR measured by in-house ELISA assay. The antibodies were detected in 7 patients with MLN (18.9%) and 3 patients with non-renal lupus disease (3.2%). PLAR staining was detected in the kidney biopsy of 5 of the 7 (71.4%) patients with MLN. a-PLAR levels were associated with active disease but not proteinuria levels. Presence of a-PLAR antibodies at baseline was associated with worse remission rates and longer time to remission compared to those patients serologically negative.
a-PLAR antibodies can be detected with low prevalence in MLN patients, but their detection is associated with a worse renal prognosis.
在大多数特发性膜性肾病患者中已鉴定出抗M型磷脂酶A2受体抗体（a-PLAR），但在膜性狼疮性肾炎（MLN）中的患病率仍不清楚。本研究的目的是评估一大群狼疮性肾炎患者中a-PLAR抗体的患病率。
采用酶联免疫吸附测定（ELISA）法检测190例系统性红斑狼疮患者血清中的a-PLAR抗体，其中37例经活检证实为MLN。阳性样本通过商用ELISA试剂盒、免疫印迹法和肾组织免疫组化法进行确认。
在190例系统性红斑狼疮患者中，共有10例（5.3%）通过内部ELISA检测发现循环a-PLAR。在7例MLN患者（18.9%）和3例非肾性狼疮疾病患者（3.2%）中检测到该抗体。在7例MLN患者中的5例（71.4%）肾活检中检测到PLAR染色。a-PLAR水平与疾病活动相关，但与蛋白尿水平无关。与血清学阴性的患者相比，基线时存在a-PLAR抗体与缓解率较差和缓解时间较长有关。
在MLN患者中可检测到低患病率的a-PLAR抗体，但其检测与较差的肾脏预后相关。
