The Significance Of Serum Anti-PLA2R Antibodies And PLA2R Glomerular Deposit In Membranous Nephropathy And The Correlation To TCM Syndromes

ObjectiveAnalyzing the significance of serum anti-PLA2R antibody and PLA2R glomerular deposit in membranous nephropathy in the diagnosis and differential diagnosis of MN,and exploring the correlation to TCM syndrome,provides the guidance basis for the clinical diagnosis and treatment.MethodsWe assessed the serum concentration of anti-PLA2R antibodies,and glomerular PLA2R deposits in37patients with biopsy-proven membranous nephropathy (including idiopathic MN and secondary MN diagnosed by the clinical and pathological results). Serum anti-PLA2R antibody level was assessed by ELISA,and glomerular PLA2R immune deposits were assessed by immune histochemical method in paraffin blocks with affinity-purified specific anti-PLA2R antibodies,to analyze the result and compare the differences between the two groups. According to TCM differentiation MN patients were divided into two groups (the spleen kidney Yang deficiency,and qi and Yin deficiency),analyzing MN syndrome characteristics of traditional Chinese medicine.Results1.The mean age was52.93±16.93years, male to female ratio was1.08:1,in27patients with IMN,and34.50±13.09years in10patients with SMN,of all secondary MN patients,4with lupus-associated MN,4with hepatitis B (HBV)-associated MN,and2with tumor-associated MN(1patients diagnosed with primary liver cancer,the other diagnosed with western-style hemangioendothelioma).2. Compared the levels of serum anti-PLA2R antibodies between IMN group and SMN group, IMN group significantly greater than SMN group(P<0.05), the sensitivity was85.2%. We detected anti-PLA2R antibodies negative in only1patient with IMN,The sensitive rate was96.3%,in SMN group7cases positive,sensitive rate was70%.3. The laboratory indexe(Serum creatinine,blood urea nitrogen,uric acid,serum albumin,blood cholesterol,blood triglycerides,fibrinogen and D-dimer,blood protein complement C4and C3,blood IgG, IgG urine protein,urine red blood cell count) has no statistical significance between IMN and SMN groups.4.The laboratory indexes(Serum creatinine,blood urea nitrogen,uric acid,serum albumin, blood cholesterol,blood triglycerides,fibrinogen and D-dimer,blood protein complement C4and C3,blood IgQIgG urine protein,urine red blood cell count) has no statistical significance between the spleen kidney Yang deficiency and qi and Yin deficiency typegroups.5. Kidney PLA2R distribution of IMN group and SMN group has statistically significant (P<0.05),the sensitivity was81.5%.6.The main certificate type of MN is spleen and kidney Yang deficiency type.Conclusion1.Detection of serum anti PLA2R antibodies had significant differences in SMN and IMN, but the positive rate in SMN group was as high as70%. Serum anti PLA2R antibodies, as MN primary or secondary index of differential diagnosis, remained to be further research;2. The diagnosis rate of IMN could be improved by detecting both serum PLA2R antibodies and kidney tissue of PLA2R.3. Spleen kidney Yang deficiency type was more than qi and Yin deficiency type in MN. This result could be used to guide the MN treatment by combining traditional Chinese and western medicine. According to the type of traditional Chinese medicine, the treatment that benefiting spleen and kidney, tonifying qi and nourishing yin were adopted on the basis of western medicine treatment, might improve the effect of clinical therapy.