Ye Nan, Yang Lei, Wang Guoqin, Cheng Wenrong, Xie Bing, Dong Hongrui, Kong Lingqiang, Zhao Xiaoyi, Geng Yanqiu, Cheng Hong
Renal Division, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Renal Division, Affiliated Hospital of Chifeng University, Neimenggu, China.
Kidney360. 2025 Feb 21;6(6):997-1006. doi: 10.34067/KID.0000000739.
Higher serum phospholipase A2 receptor antibody is an independent risk factor of arterial and venous thromboembolic events in patients with primary membranous nephropathy. The inflammatory system may play a role in this relationship.
This study investigated risk factors and possible mechanisms of arterial and venous thromboembolic events in patients with primary membranous nephropathy (pMN).
Patients with pMN confirmed by renal biopsy from June 1, 2010, to March 3, 2023, were included, and the study outcome was set as a composite end point of acute coronary syndrome, heart failure, cerebral infarction, arrhythmia, pulmonary embolism, deep venous thrombosis, and all-cause mortality.
A total of 433 pMN patients with complete data were included, with a median follow-up time of 73 (45.5–101.6) months and a composite end point rate of 10.2%. We divided all patients with events into an early event group (events occurring in the first 2 years after renal biopsy) and a late event group (events occurring after 2 years after renal biopsy) according to the time of event. It showed a lower serum albumin and higher baseline value of serum phospholipase A2 receptor (PLA2R) antibody titer and mean value of each follow-up in the early event group compared with the late event group. Cox proportional hazards model showed that after adjusting for confounding factors, in addition to older age, history of deep vein thrombosis and higher urinary protein, higher baseline serum PLA2R antibody titers (odds ratio [OR], 1.034; 95% confidence interval [CI], 1.006 to 1.063; = 0.015), and high high-sensitivity C-reactive protein level (OR, 1.049; 95% CI, 1.002 to 1.098; = 0.041), renal pathology with segmental sclerotic lesions (OR, 3.480; 95% CI, 1.338 to 9.050; = 0.011) were also independent risk factors for the occurrence of end point events. The results also showed that baseline serum IL-6 levels were significantly higher in the event group compared with the nonevent group (4.25 versus 3.21 pg/ml), and the difference was statistically significant ( = 0.009).
In the early event group, higher serum PLA2R antibody and renal pathology with segmental sclerosis lesions may affect the occurrence of cardiovascular, cerebrovascular, and venous thrombotic events. The inflammatory system may play a role in this relationship.
较高的血清磷脂酶A2受体抗体是原发性膜性肾病患者发生动脉和静脉血栓栓塞事件的独立危险因素。炎症系统可能在这种关系中起作用。
本研究调查了原发性膜性肾病（pMN）患者发生动脉和静脉血栓栓塞事件的危险因素及可能机制。
纳入2010年6月1日至2023年3月3日经肾活检确诊的pMN患者，研究结局设定为急性冠状动脉综合征、心力衰竭、脑梗死、心律失常、肺栓塞、深静脉血栓形成和全因死亡率的复合终点。
共纳入433例资料完整的pMN患者，中位随访时间为73（45.5 - 101.6）个月，复合终点发生率为10.2%。我们根据事件发生时间将所有发生事件的患者分为早期事件组（肾活检后前2年发生的事件）和晚期事件组（肾活检后2年以后发生的事件）。结果显示，与晚期事件组相比，早期事件组血清白蛋白较低，血清磷脂酶A2受体（PLA2R）抗体滴度基线值及各次随访均值较高。Cox比例风险模型显示，在调整混杂因素后，除年龄较大、有深静脉血栓形成病史和尿蛋白较高外，较高的基线血清PLA2R抗体滴度（比值比[OR]，1.034；95%置信区间[CI]，1.006至1.063；P = 0.015）、高敏C反应蛋白水平较高（OR，1.049；95%CI，1.002至1.098；P = 0.041）、伴有节段性硬化病变的肾脏病理（OR，3.480；95%CI，1.338至9.050；P = 0.011）也是终点事件发生的独立危险因素。结果还显示，事件组基线血清IL - 6水平显著高于无事件组（4.25对3.21 pg/ml），差异有统计学意义（P = 0.009）。
在早期事件组中，较高的血清PLA2R抗体及伴有节段性硬化病变的肾脏病理可能影响心血管、脑血管及静脉血栓事件的发生。炎症系统可能在这种关系中起作用。
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