Department of Nephrology, The Second Hospital of Longyan, Fujian, 364000, China.
Department of Nephrology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 35000, China.
BMC Nephrol. 2019 Sep 18;20(1):360. doi: 10.1186/s12882-019-1544-2.
The diagnostic value of serum M-type phospholipase A2 receptor antibody (sPLA2R-ab) expression in patients with primary membranous nephropathy (PMN) has been established. However, the association between sPLA2R-ab and clinical remission remains uncertain.
We systematically searched the literature for clinical trials regarding the correlation between sPLA2R-ab expression and clinical remission of PMN patients. Meta-analysis was performed to determine this association. Subgroup analysis, funnel plots, and sensitivity analysis were also performed to investigate heterogeneity or bias.
A total of 11 trials involving 824 patients were included. Patients with positive sPLA2R-ab had a poor clinical remission rate (RR = 0.76, 95%CI 0.68-0.86, P < 0.0001; I = 39%), a higher titer of sPLA2R-ab had a lower chance of clinical remission (RR = 0.72, 95%CI 0.59-0.87, P = 0.0006; I = 42%),and a higher risk of renal failure (RR = 4.85, 95% CI, 1.83-12.85, P = 0.002; I = 0%), without affecting relapse (RR = 0.97, 95% CI, 0.55-1.70; P = 0.92, I = 0%). Subgroup analysis by treatment strategies, assay methods, ethnicity, gender, renal function, the approach of ruling out SMN, and the ratio of patients with nephrotic-range proteinuria at baseline showed no significant association between these factors with the prognostic value of sPLA2R-ab for PMN patients. No significant publication bias was found.
This meta-analysis adds to the evidence for current guidelines that sPLA2R-ab acts as not only a diagnostic marker but also a pivotal predictor for clinical remission. Therefore, sPLA2R-ab can be considered as a prognostic factor for stratifying PMN patients.
血清 M 型磷脂酶 A2 受体抗体（sPLA2R-ab）在原发性膜性肾病（PMN）患者中的诊断价值已得到确立。然而，sPLA2R-ab 与临床缓解之间的关联仍不确定。
我们系统地检索了关于 sPLA2R-ab 表达与PMN 患者临床缓解相关性的临床试验文献。采用荟萃分析来确定这种相关性。还进行了亚组分析、漏斗图和敏感性分析，以研究异质性或偏倚。
共纳入 11 项涉及 824 例患者的临床试验。sPLA2R-ab 阳性患者的临床缓解率较差（RR=0.76，95%CI 0.68-0.86，P<0.0001；I²=39%），sPLA2R-ab 滴度较高则临床缓解的可能性较低（RR=0.72，95%CI 0.59-0.87，P=0.0006；I²=42%），发生肾衰竭的风险较高（RR=4.85，95%CI，1.83-12.85，P=0.002；I²=0%），但对复发没有影响（RR=0.97，95%CI，0.55-1.70；P=0.92，I²=0%）。按治疗策略、检测方法、种族、性别、肾功能、排除 SMN 的方法以及基线时肾病范围蛋白尿患者的比例进行的亚组分析显示，这些因素与 sPLA2R-ab 对PMN 患者的预后价值之间无显著关联。未发现显著的发表偏倚。
这项荟萃分析为当前指南增加了证据，表明 sPLA2R-ab 不仅是一种诊断标志物，还是临床缓解的关键预测因子。因此，sPLA2R-ab 可被视为 PMN 患者分层的预后因素。
