Department of Nephrology, Hebei General Hospital, Shijiazhuang, 050000, China.
Sci Rep. 2023 Oct 3;13(1):16608. doi: 10.1038/s41598-023-43766-8.
Patients with diabetes mellitus complicated with proteinuria can be diabetic nephropathy (DN), diabetic complicated with non-diabetic kidney disease (NDKD), or DN with NDKD. Among these membranous nephropathy accounted for a large proportion of DN with NDRD. At present, serum anti-phospholipase A2 receptor (PLA2R) antibody is widely used in the diagnosis and evaluation of therapy in idiopathic membranous nephropathy, our study aimed to investigate the diagnostic significance of anti-PLA2R antibody in type 2 diabetes mellitus (T2DM) patients with proteinuria, providing a method for patients with contraindications of kidney biopsy. Eighty-seven T2DM patients with proteinuria who went on kidney biopsy were divided into the DN group, idiopathic membranous nephropathy (IMN) group, and others group according to their pathological results. In our study, 52.87% and 28.74% of patients were found to have IMN and diabetic nephropathy respectively. The levels of anti-PLA2R antibody, total cholesterol, triglyceride, and estimated glomerular filtration rate (eGFR) were higher in the IMN group, while the prevalence of diabetic retinopathy (DR), systolic blood pressure (SBP) and HbA1c were higher in the DN group. For T2DM patients with proteinuria, anti-PLA2R antibody (AUC = 0.904, 95%CI 0.838-0.970) has a high diagnostic value for IMN. The duration of diabetes (OR = 0.798, P = 0.030), eGFR level (OR = 1.030, P = 0.024), and positive anti-PLA2R antibody (OR = 72.727, P < 0.001) favor the diagnosis of IMN, while DR (OR = 50.234, P < 0.001), SBP (OR = 1.041, P = 0.030), and negative anti-PLA2R antibody (OR = 0.008, P = 0.001) is beneficial to the diagnosis of DN. Our study found that NDKD is not uncommon in patients with T2DM and proteinuria, and IMN was the main pathological type. Positive anti-PLA2R antibody has a strong accuracy in the diagnosis of IMN in patients with T2DM and proteinuria.
患者患有糖尿病并伴有蛋白尿,可能患有糖尿病肾病(DN)、糖尿病合并非糖尿病肾脏疾病(NDKD)或 DN 合并 NDKD。其中,膜性肾病在 DN 合并 NDKD 中占很大比例。目前,血清抗磷酯酶 A2 受体(PLA2R)抗体广泛应用于特发性膜性肾病的诊断和疗效评估,本研究旨在探讨抗 PLA2R 抗体在 2 型糖尿病(T2DM)伴蛋白尿患者中的诊断意义,为有肾活检禁忌证的患者提供一种方法。87 例蛋白尿行肾活检的 T2DM 患者根据病理结果分为 DN 组、特发性膜性肾病(IMN)组和其他组。在本研究中,分别有 52.87%和 28.74%的患者被发现患有 IMN 和糖尿病肾病。IMN 组的抗 PLA2R 抗体、总胆固醇、甘油三酯和估算肾小球滤过率(eGFR)水平较高,而 DN 组的糖尿病视网膜病变(DR)、收缩压(SBP)和 HbA1c 患病率较高。对于 T2DM 伴蛋白尿患者,抗 PLA2R 抗体(AUC=0.904,95%CI 0.838-0.970)对 IMN 具有较高的诊断价值。糖尿病病程(OR=0.798,P=0.030)、eGFR 水平(OR=1.030,P=0.024)和抗 PLA2R 抗体阳性(OR=72.727,P<0.001)有利于 IMN 的诊断,而 DR(OR=50.234,P<0.001)、SBP(OR=1.041,P=0.030)和抗 PLA2R 抗体阴性(OR=0.008,P=0.001)有利于 DN 的诊断。本研究发现,T2DM 伴蛋白尿患者中 NDKD 并不少见,主要的病理类型为 IMN。抗 PLA2R 抗体阳性对 T2DM 伴蛋白尿患者的 IMN 诊断具有较强的准确性。