Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China.
Department of Nephrology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.
Am J Nephrol. 2022;53(2-3):129-138. doi: 10.1159/000521836. Epub 2022 Mar 10.
Anti-phospholipase A2 receptor antibody (PLA2R-Ab) is highly specific for primary membranous nephropathy (PMN). Here, we compare the diagnostic value of different circulating PLA2R-Ab cutoff titers in multicenter cohorts, with particular focus on determining the optimal cutoff value for Chinese patients.
In total, 288 patients with PMN and 301 with other nephropathies were recruited retrospectively from five hospitals in China between September 2011 and October 2018. PLA2R-Ab in serum obtained at renal biopsy was determined by enzyme-linked immunosorbent assay. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curve of PLA2R-Ab in diagnosing PMN were assessed. Diagnostic efficiency was evaluated by internal validation.
The sensitivity, specificity, PPV, NPV, and Youden index for PMN diagnosis were 71%, 90%, 88%, 75%, and 0.61 at the cutoff of 3.8 RU/mL; 74%, 86%, 84%, 76%, and 0.60 at 2.7 RU/mL; 68%, 92%, 90%, 73%, and 0.60 at 5.2 RU/mL; 64%, 95%, 93%, 72%, and 0.59 at 9.0 RU/mL; 57%, 96%, 94%, 68%, and 0.54 at 14.0 RU/mL; 51%, 97%, 95%, 66%, and 0.49 at 20.0 RU/mL; 47%, 98%, 96%, 64%, and 0.45 at 40.0 RU/mL, respectively. The area under the ROC curve was 0.83.
By comprehensively considering specificity and sensitivity, we show that 3.8 RU/mL is the optimal cutoff of PLA2R-Ab in Chinese PMN patients, with a sensitivity of 71% and a specificity of 90%. The cutoff values were 5.2 RU/mL and 9.0 RU/mL when the diagnostic specificity was increased to 92% and 95%, respectively.
抗磷脂酶 A2 受体抗体（PLA2R-Ab）对原发性膜性肾病（PMN）具有高度特异性。在这里，我们比较了不同循环 PLA2R-Ab 截断滴度在多中心队列中的诊断价值，特别关注确定中国患者的最佳截断值。
回顾性收集 2011 年 9 月至 2018 年 10 月中国五家医院 288 例 PMN 患者和 301 例其他肾病患者的临床资料。采用酶联免疫吸附试验（ELISA）检测血清中 PLA2R-Ab。评估 PLA2R-Ab 诊断 PMN 的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和受试者工作特征（ROC）曲线。通过内部验证评估诊断效率。
以 3.8 RU/mL 为截断值时，PMN 诊断的敏感性、特异性、PPV、NPV 和约登指数分别为 71%、90%、88%、75%和 0.61；2.7 RU/mL 时为 74%、86%、84%、76%和 0.60；5.2 RU/mL 时为 68%、92%、90%、73%和 0.60；9.0 RU/mL 时为 64%、95%、93%、72%和 0.59；14.0 RU/mL 时为 57%、96%、94%、68%和 0.54；20.0 RU/mL 时为 51%、97%、95%、66%和 0.49；40.0 RU/mL 时为 47%、98%、96%、64%和 0.45。ROC 曲线下面积为 0.83。
综合考虑特异性和敏感性，我们发现 PLA2R-Ab 在 3.8 RU/mL 时对中国 PMN 患者的诊断具有最佳的敏感性（71%）和特异性（90%），当诊断特异性提高到 92%和 95%时，截断值分别为 5.2 RU/mL 和 9.0 RU/mL。
