Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China,
Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Kidney Blood Press Res. 2023;48(1):102-113. doi: 10.1159/000529415. Epub 2023 Jan 31.
Idiopathic membranous nephropathy (IMN) is the most common form of primary nephrotic syndrome in adults. Antibodies against the M-type phospholipase A2 receptor (PLA2R-ab) are considered as diagnostic biomarkers of IMN.
Here, we performed an updated meta-analysis to assess the diagnostic value of PLA2R-ab for clinical remission in IMN patients.
PubMed, Embase, and Cochrane databases were searched for relevant studies published before September 2022. Odds ratios and corresponding 95% confidence intervals were determined using a fixed or random effects model. The heterogeneity among studies was explored by subgroup analysis.
Sixteen studies involving 1,761 IMN participants were included. There were significant differences between PLA2R-ab (+) and PLA2R-ab (-) patients in terms of complete remission (CR) and spontaneous remission. The rates of partial remission (PR) and relapse were similar between the two groups. Patients with PLA2R-ab (-) were at a higher CR rate when treated with a calcineurin inhibitor or a treatment course for 3 months and 6 months, while the spontaneous remission rate was higher in PLA2R-ab seronegative patients from Asia. However, the CR and spontaneous remission rate only significantly declined in IMN patients with the highest titer, but not a middle titer, when compared to those with the lowest titer.
In contrast with previous meta-analyses, our results verified that PLA2R-ab can likely predict CR and spontaneous remission in IMN patients, instead of PR and relapse. Race, immunosuppressive agents, and duration of treatment may affect the prognostic value of PLA2R-ab. Considering that the remission rate of IMN patients with a middle level of PLA2R-ab was not different from that of patients with the lowest level, a proper cut-off value of PLA2R-ab for prognosis should be clarified.
特发性膜性肾病（IMN）是成人原发性肾病综合征中最常见的形式。针对 M 型磷脂酶 A2 受体（PLA2R-ab）的抗体被认为是 IMN 的诊断生物标志物。
本研究进行了一项更新的荟萃分析，以评估 PLA2R-ab 在 IMN 患者临床缓解中的诊断价值。
检索了截至 2022 年 9 月前发表的相关研究，使用固定或随机效应模型确定比值比和相应的 95%置信区间。通过亚组分析探讨研究间的异质性。
纳入了 1761 例 IMN 患者的 16 项研究。PLA2R-ab(+)和 PLA2R-ab(-)患者在完全缓解（CR）和自发缓解方面存在显著差异。两组患者的部分缓解（PR）和复发率相似。在接受钙调磷酸酶抑制剂或 3 个月和 6 个月治疗时，PLA2R-ab(-)患者的 CR 率较高，而亚洲 PLA2R-ab 阴性患者的自发缓解率较高。然而，只有在与最低滴度相比时，IMN 患者中 PLA2R-ab 滴度最高的患者的 CR 和自发缓解率才显著下降，而不是滴度中等的患者。
与之前的荟萃分析结果相反，我们的结果证实，PLA2R-ab 可能能够预测 IMN 患者的 CR 和自发缓解，而不是 PR 和复发。种族、免疫抑制剂和治疗持续时间可能影响 PLA2R-ab 的预后价值。鉴于 PLA2R-ab 中值水平的 IMN 患者的缓解率与最低水平的患者无差异，应明确 PLA2R-ab 预后的适当截断值。
