Department of Nephrology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
Department of Cardiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China.
Curr Med Sci. 2020 Aug;40(4):683-690. doi: 10.1007/s11596-020-2246-5. Epub 2020 Aug 29.
Recent studies suggested that serum secretory phospholipase A2 group IB (sPLA2-IB) was increased in idiopathic membranous nephropathy (IMN). However, the interference of high lipemia on the sPLA2-IB levels was not taken into account in these studies. The present study aimed to investigate the correlation between sPLA2-IB and lipemia, and the clinical merit of sPLA2-IB in the prediction of prognosis of IMN patients. A total of 64 IMN patients, 39 immunoglobulin A nephropathy (IgAN) patients and 64 healthy controls were included in the study. The levels of serum sPLA2-IB, lipemia and proteinuria were measured. Fifty IMN patients were followed up for 6 months. Pathologic stages were made for all IgAN and IMN patients. The results showed that the levels of serum sPLA2-IB, cholesterol and low-density lipoprotein cholesterol (LDL-C) were significantly higher, and the levels of albumin and high-density lipoprotein cholesterol (HDL-C) were significantly lower in IMN patients than in healthy controls and IgAN patients. Serum sPLA2-IB levels were also found to be higher in IgAN patients than in heathy controls, but the association of serum sPLA2-IB levels with proteinuria, cholesterol and albumin was only shown in IMN patients. Antibody against M-type receptor for secretory phospholipase A2 (PLA2R1) was positive in 81.3% IMN patients. Glomerular sPLA2-IB deposition, podocyte fused processes, and density deposition on thickened basement membrane were seen in IMN patients, but not in IgAN patients. IMN patients with lower sPLA2-IB and proteinuria levels were found to have better outcome after the 6-month follow-up. In IMN patients, sPLA2-IB levels were significantly increased in both serum and renal tissue. In conclusion, serum sPLA2-IB was closely correlated with proteinuria, albumin and cholesterol, and IMN patients with lower sPLA2-IB levels were more likely to achieve a better outcome.
最近的研究表明，特发性膜性肾病（IMN）患者血清分泌型磷脂酶 A2 组 IB（sPLA2-IB）水平升高。然而，这些研究并未考虑高脂血症对 sPLA2-IB 水平的干扰。本研究旨在探讨 sPLA2-IB 与脂血症的相关性，以及 sPLA2-IB 在预测 IMN 患者预后中的临床价值。本研究共纳入 64 例 IMN 患者、39 例免疫球蛋白 A 肾病（IgAN）患者和 64 名健康对照者。检测血清 sPLA2-IB、脂血症和蛋白尿水平。对 50 例 IMN 患者进行了 6 个月的随访。对所有 IgAN 和 IMN 患者进行了病理分期。结果显示，与健康对照组和 IgAN 患者相比，IMN 患者血清 sPLA2-IB、胆固醇和低密度脂蛋白胆固醇（LDL-C）水平显著升高，白蛋白和高密度脂蛋白胆固醇（HDL-C）水平显著降低。与健康对照组相比，IgAN 患者血清 sPLA2-IB 水平也较高，但仅在 IMN 患者中观察到血清 sPLA2-IB 水平与蛋白尿、胆固醇和白蛋白之间的相关性。81.3%的 IMN 患者抗 M 型分泌型磷脂酶 A2 受体（PLA2R1）抗体阳性。IMN 患者肾小球 sPLA2-IB 沉积、足细胞融合过程和增厚基底膜上的密度沉积，而 IgAN 患者则无此现象。经过 6 个月的随访，发现 sPLA2-IB 和蛋白尿水平较低的 IMN 患者预后更好。在 IMN 患者中，血清和肾组织中 sPLA2-IB 水平均显著升高。综上所述，血清 sPLA2-IB 与蛋白尿、白蛋白和胆固醇密切相关，sPLA2-IB 水平较低的 IMN 患者更有可能获得更好的预后。
