血清 PLA2R 抗体作为原发性膜性肾病静脉血栓栓塞风险的预测生物标志物。

Serum PLA2R antibody as a predictive biomarker for venous thromboembolism risk in primary membranous nephropathy.

机构信息

Department of Nephrology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China; Department of Nephrology, China-Japan Friendship Hospital, Beijing, China.

Department of Nephrology, China-Japan Friendship Hospital, Beijing, China.

出版信息

Med Clin (Barc). 2023 Nov 24;161(10):417-421. doi: 10.1016/j.medcli.2023.06.007. Epub 2023 Jul 31.

DOI:10.1016/j.medcli.2023.06.007

PMID:37532619

Abstract

BACKGROUND

Patients with nephrotic syndrome are at high risk of venous thromboembolism (VTE), especially for primary membranous nephropathy (PMN). The phospholipase A2 receptor (PLA2R) is a marker of primary membranous nephropathy activity. This study investigated the predictive value of PLA2R antibodies in PMN for VTE.

METHODS

In this retrospective study, we included 97 PMN patients and evaluated the predictive value of serum PLA2R antibodies for VTE risk. Lower extremity venous ultrasound, renal vein ultrasound, or spiral computed tomography pulmonary arteriography were used to assess VTE events. Serum anti-PLA2R antibodies were detected by enzyme-linked immunosorbent assay (ELISA). The risk of VTE was stratified according to serum albumin levels.

RESULTS

Twenty PMN patients (21%) had thromboembolic events. Eight (15%) of patients with serum albumin >25g/l developed VTE, 6 of whom were positive for serum PLA2R antibodies. Positive serum PLA2R antibodies were significantly associated with VTE events in patients with serum albumin >25g/l (p=0.01). Age, sex, blood creatinine, serum albumin, and 24-h urine protein levels were not statistically different between the two groups. Kaplan-Meier analysis using the log-rank test revealed anti-PLA2R positive membranous nephropathy patients had more probability of VTE events than anti-PLA2R negative patients. Univariate Cox proportional hazards analysis revealed that lnPLA2R-Ab is an unfavorable predictor for VTE events in patients with serum albumin >25g/l (hazard ratio (HR) 2.1, p=0.01).

CONCLUSIONS

The PLA2R antibody was a risk predictor for thromboembolic events in patients with primary membranous nephropathy with serum albumin >25g/l.

摘要

背景

肾病综合征患者发生静脉血栓栓塞症（VTE）的风险较高，尤其是原发性膜性肾病（PMN）患者。磷脂酶 A2 受体（PLA2R）是原发性膜性肾病活动的标志物。本研究旨在探讨 PLA2R 抗体在预测原发性膜性肾病患者 VTE 风险中的作用。

方法

本回顾性研究纳入了 97 例原发性膜性肾病患者，评估了血清 PLA2R 抗体对 VTE 风险的预测价值。采用下肢静脉超声、肾静脉超声或螺旋 CT 肺动脉造影评估 VTE 事件。采用酶联免疫吸附试验（ELISA）检测血清抗 PLA2R 抗体。根据血清白蛋白水平对 VTE 风险进行分层。

结果

20 例（21%）原发性膜性肾病患者发生血栓栓塞事件。血清白蛋白＞25g/l 的患者中 8 例（15%）发生 VTE，其中 6 例血清 PLA2R 抗体阳性。血清白蛋白＞25g/l 的患者中，血清 PLA2R 抗体阳性与 VTE 事件显著相关（p=0.01）。两组间年龄、性别、血肌酐、血清白蛋白和 24 小时尿蛋白水平无统计学差异。对数秩检验的 Kaplan-Meier 分析显示，抗 PLA2R 阳性膜性肾病患者发生 VTE 的概率高于抗 PLA2R 阴性患者。单因素 Cox 比例风险分析显示，lnPLA2R-Ab 是血清白蛋白＞25g/l 的患者发生 VTE 的不利预测因子（风险比（HR）2.1，p=0.01）。