| Objective: Determine the concentration of serum anti-M-type phospholipase A2 receptor(PLA2R)antibody in patients with idiopathic membranous nephropathy(Idiopathic Membranous Nephropathy,IMN),analyze the correlation between the concentration level of anti-PLA2 R antibody and the 24-hour urinary protein(pro),serum albumin(ALB),blood urea nitrogen(BUN),blood creatinine(CREA),uric acid(UA)and serum cholesterol(CHOL),and follow up the patients for 6 months and investigate the correlation between anti-PLA2 R antibody and treatment response of patients with idiopathic membranous nephropathy.Methods:1 We selected 85 patients of nephrology department in the the Second Hospital of Hebei Medical University from October 2014 to April 2015,who were diagnosed idiopathic membranous nephropathy by renal biopsy,47 men,38 women,average age:(43.8±12.9)years old.Among them,there were 80 cases with membranous nephropathy in stage I,44 men,36 women,average age:(44.4±26.1)years old,5 cases with membranous nephropathy in stage II,3 men,2 women,average age:(47.6±20.7)years old.Apart from secondary MN,screening for hepatitis,tumor marker and the autoantibody were all negative.All of patients were never accepted hormones and immunosuppressive therapy before.2 Detect serum Anti-PLA2 R Ab by enzyme linked immuno sorbent assay(ELISA),Anti-PLA2 R Ab detection value ≥ 20RU/ml was regarded as positive,Anti-PLA2 R Ab detection value < 20RU/ml was regarded as negative.Divide patients into three groups according to the level of Anti-PLA2 R Ab: Anti-PLA2 R Ab negative group,Anti-PLA2 R Ab low concentration group,Anti-PLA2 R Ab high concentration group.3 Patients received angiotensin converting enzyme inhibitors(ACEI)/ angiotensin Ⅱ receptor blocker(ARB)or hormone and immunosuppressants for six months,then analyze the relation between Anti-PLA2 R Ab concentration and treatment response.4 All these date was undertook statistical analysis by SPSS13.0,P<0.05 represented the difference was statistically significance.Result:1 Clinical indexes of IMN patients and Serum Anti-PLA2 R Ab.Beforte treatment,the Anti-PLA2 R Ab in serum were found in 82.35% patients with IMN.Anti-PLA2 R Ab positive patients with IMN were separated by Anti-PLA2 R Ab median concentration(M = 100.01 RU / ml),all patients were divided into Anti-PLA2 R Ab high concentration group [(101.09~1102.571)RU/ml],Anti-PLA2 R Ab low concentration group [(20.69~100.01)RU/ml] and Anti-PLA2 R Ab negative group [(1.76~18.69)RU/ml].There wsa no statistical difference among three group at age,BMI,blood pressure,serum creatinine,triglyceride,Hemoglobin,blood sugar.24 h proteinuria of Anti-PLA2 R Ab high concentration group [(6.80±1.89)g/d] was significantly higher than Anti-PLA2 R Ab low concentration group [(4.96±1.88)g/d] and Anti-PLA2 R Ab negative group [(3.00±2.59)g/d],Anti-PLA2 R Ab low concentration group [(4.96±1.88)g/d] was significantly higher than Anti-PLA2 R Ab negative group [(3.00±2.59)g/d](P<0.05).Uric acid of Anti-PLA2 R Ab high concentration group [(342.05±75.84)umol/L] was significantly higher than Anti-PLA2 R Ab negative group [(284.60±75.84)umol/L](P<0.05),there was no statisticlly difference be-tween AntiPLA2 R Ab high concentration group [(342.05±75.84)umol/L] and Anti-PLA2 R Ab low concentration group [(330.77 ±75.59)umol/L](P>0.05),there was no statisticlly difference between Anti-PLA2 R Ab low concentration group [(330.77 ±75.59)umol/L] and Anti-PLA2 R Ab negative group [(284.60±75.84)umol/L](P>0.05).Total cholesterol Anti-PLA2 R Ab high concentration group [(7.61±1.87)mmol/L] was significantly higher than Anti-PLA2 R Ab low concentration group [(6.72±1.73)mmol/L](P<0.05),there was no statisticlly difference between Anti-PLA2 R Ab high concentration group [(7.61±1.87)mmol/L] and Anti-PLA2 R Ab negative group [(6.76±1.60)mmol/L](P>0.05),there was no statisticlly difference between Anti-PLA2 R Ab low concentration group [(6.72±1.73)mmol/L] and Anti-PLA2 R Ab negative group [(6.76±1.60)mmol/L](P>0.05).Serum albumin of Anti-PLA2 R Ab high concentration group [(23.88±5.29)g/L] was significantly lower than Anti-PLA2 R Ab negative group [(33.66±5.59)g/L](P<0.05),Anti-PLA2 R Ab low concentration group [(24.04±4.49)g/L] was significantly lower than Anti-PLA2 R Ab negative group [(33.66±5.59)g/L](P<0.05),there was no statistic-ally difference between Anti-PLA2 R Ab high concentration group [(23.88± 5.29)g/L] and Anti-PLA2 R Ab low concentration group [(24.04±4.49)g/L](P>0.05).2 Correlation between serum Anti-PLA2 R Ab and clinical indexes of IMN patients.The Anti-PLA2 R Ab concentration was significantly negatively correlated with serum albumin(r=-0.318,P=0.004).The Anti-PLA2 R Ab concentration was significantly positively correlated with total cholesterol(r=0.312,P=0.005),24 h proteinurine(r=0.247,P=0.026).P<0.05.Multiple regression result showed that 24 h proteinurine and total cholesterol were associated with Anti-PLA2 R Ab independently.The regression equation was Y=-129.029+26.612[total cholesterol]+17.572[24h proteinurine].3 The change of clinical indexes of IMN patients after 6 months treatment.After 6 months treatment 24 h proteinurine of Anti-PLA2 R Ab high concentration group[(3.9±3.35)g/d] was significantly higher than Anti-PLA2 R Ab low concentration group[(2.5±1.52)g/d] and Anti-PLA2 R Ab negative group[(0.72±0.89)g/d](P<0.05),Anti-PLA2 R Ab low concentration group [(2.5±1.52)g/d] was significantly higher than Anti-PLA2 R Ab negative group [(0.72±0.89)g/d](P<0.05).Total cholesterol of Anti-PLA2 R Ab high concentration group[(6.9±1.34)mmol/L] was significantly higher than AntiPLA2 R Ab low concentration group[(5.9±0.85)mmol/L] and Anti-PLA2 R Ab negative group[(5.4±0.56)mmol/L](P<0.05),there was no statisticlly differ-ence between Anti-PLA2 R Ab low concentration group[(5.9±0.85)mmol/L] and Anti-PLA2 R Ab negative group[(5.4±0.56)mmol/L](P>0.05).Serum albumin of Anti-PLA2 R Ab high concentration group[(32.57±7.34)g/L] was significantly lower than Anti-PLA2 R Ab nega-tive group [(37.58±5.03)g/L](P<0.05),Anti-PLA2 R Ab low concentration group[(33.17±4.88)g/L] was significantly lower than Anti-PLA2 R Ab low concentration group[(33.17±4.88)g/L](P < 0.05),there was no statisticlly difference between Anti-PLA2 R Ab high concentration group[(32.57±7.34)g/L] and Anti-PLA2 R Ab low concentration group[(33.17±4.88)g/L](P>0.05).4 Serum Anti-PLA2 R Ab and treatment response of IMN patients.The rate of complete remission of Anti-PLA2 R Ab high concentration group(6.06%)was significantly lower than Anti-PLA2 R Ab negative group(64.29%)(P<0.05),Anti-PLA2 R Ab low concentration(14.71%)was significantly lower than Anti-PLA2 R Ab negative group(64.29%)(P<0.05),there was no statisticlly difference between Anti-PLA2 R Ab high concen-tration group(6.06%)and Anti-PLA2 R Ab low concentration(14.71%)(P>0.05).There was no statisticlly difference of The rate of partial remission among thress groups(P > 0.05).The rate of no remission of Anti-PLA2 R Ab high concentration group(45.46%)was significantly higher than Anti-PLA2 R Ab negative group(0%)(P<0.05),there was no statisticlly difference between Anti-PLA2 R Ab high concentration group(45.46%)and Anti-PLA2 R Ab low concentration group(23.53%)(P>0.05),there was no statisticlly difference between Anti-PLA2 R Ab low concentration group(23.53%)and Anti-PLA2 R Ab negative group(0%)(P>0.05).5 Comparison of serum Anti-PLA2 R Ab among three treatment response group.According to treatment response,patients with IMN were divided into three groups,complete remission group 16 patients,partial remission group 42 patients,no remission group 23 patients.Serum Anti-PLA2 R Ab concentration of the no remission group [139.81(77.48-304.326)RU/ml] was significantly higher than the partial remission group [81.45(48.86-142.6)RU/ml] and the complete remission group [14.03(1.88-55.9)RU/ml].Serum Anti-PLA2 R Ab concentration of the partial remission group [81.45(48.86-142.6)RU/ml] was higher than the complete remission group [14.03(1.88-55.9)RU/ml](P<0.05).Conclusions:1 The serum circulating anti-PLA2 R antibody is a specific index that can be used to diagnose IMN.2 The Anti-PLA2 R Ab concentration was significantly associated with serum albumin and 24 h proteinuria independently.3 Serum anti-PLA2 R antibody is closely related to the treatment response of IMN patients.Patients with higher Serum anti-PLA2 R antibody concentration have a worse treatment response. |
PDF Full Text Request