Zheng Tianyu, Qin Yuan, Tang Xuanli, Bi Peng, Hui Xuxiang, Zhou Zixuan, Fu Yulin, Sheng Huiming, Zhou Xiumei, Zhao Xueqin, Du Yuanyuan, He Qiang, Huang Biao
From College of Life Sciences and Medicine, Zhejiang Sci-Tech University, Hangzhou, China (Zheng, Qin, Hui, Z Zhou, Fu, X Zhou, Zhao, Huang).
The Department of Nephrology (Key Laboratory of Kidney Disease Prevention and Control Technology), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China (Tang, Bi, Du).
Arch Pathol Lab Med. 2025 Jul 1;149(7):e151-e159. doi: 10.5858/arpa.2024-0161-OA.
CONTEXT.—: M-type phospholipase A2 receptor (PLA2R) is the major autoantigen of membranous nephropathy (MN). As the specific antibodies of MN, the correlation between serum PLA2R antibody (sPLA2R-Ab) levels and PLA2R-associated MN (PMN) risk stratification is still controversial.
OBJECTIVE.—: To apply the time-resolved fluorescence immunoassay (TRFIA) method on urine PLA2R-Ab (uPLA2R-Ab), detect, and then establish a more sensitive method of combined serum and urine PLA2R-Ab detection for PMN hazard stratification.
DESIGN.—: A highly sensitive TRFIA method was used to detect the initial serum and urine samples of patients with PMN. Patients were grouped into remission and nonremission groups according to the outcomes after 12 months of treatment and the data were analyzed.
RESULTS.—: The cutoff values of sPLA2R-IgG (sPLA2R-immunoglobulin G), uPLA2R-IgG, sPLA2R-IgG4, and uPLA2R-IgG4 for distinguishing between remission and nonremission groups were 50 relative units (RU)/mL, 3.51 RU/mL, 6835 ng/mL, and 143.4 ng/mL, respectively. The average value in the remission group for sPLA2R-IgG, uPLA2R-IgG, sPLA2R-IgG4, and uPLA2R-IgG4 was 37.39 RU/mL, 1.10 RU/mL, 3498.99 ng/mL, and 33.83 ng/mL, respectively. The average value in the nonremission group for sPLA2R-IgG, uPLA2R-IgG, sPLA2R-IgG4, and uPLA2R-IgG4 was 279.96 RU/mL, 45.36 RU/mL, 25762.47 ng/mL, and 1383.89 ng/mL, respectively. For sPLA2R-Ab as the primary factor, in combination with uPLA2R-Ab, the high-risk predictive value of combined detection of serum and urine PLA2R-IgG and of serum and urine PLA2R-IgG4 was upgraded from 54.55% to 100% and from 75% to 100%, respectively.
CONCLUSIONS.—: A highly sensitive TRFIA method was applied in this study; the combined detection of serum and urine PLA2R-Ab improves the efficiency of PMN risk stratification, and can provide a better assessment of PMN monitoring.
M型磷脂酶A2受体（PLA2R）是膜性肾病（MN）的主要自身抗原。作为MN的特异性抗体，血清PLA2R抗体（sPLA2R-Ab）水平与PLA2R相关MN（PMN）风险分层之间的相关性仍存在争议。
应用时间分辨荧光免疫分析法（TRFIA）检测尿PLA2R-Ab（uPLA2R-Ab），然后建立一种更敏感的血清和尿PLA2R-Ab联合检测方法用于PMN危险分层。
采用高灵敏度TRFIA方法检测PMN患者的初始血清和尿液样本。根据治疗12个月后的结果将患者分为缓解组和未缓解组，并对数据进行分析。
区分缓解组和未缓解组的sPLA2R-IgG（sPLA2R免疫球蛋白G）、uPLA2R-IgG、sPLA2R-IgG4和uPLA2R-IgG4的临界值分别为50相对单位（RU）/mL、3.51 RU/mL、6835 ng/mL和143.4 ng/mL。缓解组中sPLA2R-IgG、uPLA2R-IgG、sPLA2R-IgG4和uPLA2R-IgG4的平均值分别为37.39 RU/mL、1.10 RU/mL、3498.99 ng/mL和33.83 ng/mL。未缓解组中sPLA2R-IgG、uPLA2R-IgG、sPLA2R-IgG4和uPLA2R-IgG4的平均值分别为279.96 RU/mL、45.36 RU/mL、25762.47 ng/mL和1383.89 ng/mL。以sPLA2R-Ab作为主要因素，结合uPLA2R-Ab，血清和尿PLA2R-IgG联合检测以及血清和尿PLA2R-IgG4联合检测的高危预测值分别从54.55%提高到100%和从75%提高到100%。
本研究应用了高灵敏度TRFIA方法；血清和尿PLA2R-Ab联合检测提高了PMN风险分层的效率，并能为PMN监测提供更好的评估。
