| Objective: To assess the association of serum anti-phospholipase A2-receptor(PLA2R)antibody and clinical outcome in patients with idiopathic membranous nephropathy(IMN).Methods: 1.The study recruited 259 patients with IMN who were diagnosed by renal biopsy from March 2011 to February 2016 in the Nephrology department,including 158 men and 119 women,and the average age 41.75±14.45 years old.The deadline of follow-up was July 2016(Follow–up serum sample were obtained from July 2015 to July 2016).2.We gathered the baseline and follow-up characteristics,including sex,age,and the laboratory indicators,for example Records general information and clinical data of the patient,including routine urine analysis,random urinary protein/creatinine ratio,24-hour urine protein,serum albumin(ALB),serum creatinine(Scr),estimate glomerular filtration rate(e GFR),blood urea nitrogen(BUN),triglyceride(TG),cholesterol(TC),and treatments.3.We detected the obtained serum for the baseline and follow-up by the enzyme linked immunosorbent assay(ELISA)kit for anti-PLA2 R antibody.According to the cut-off value(20RU/ml),we divided the patients into two group,that is one group for seropositive patients and another group for seronegative patients.4.We analyzed the results by SPSS19.0 software and Stata14.0 for statistical analysis.P<0.05 represents the difference.Results: 1.133 out of 259 patients with IMN were seropositive for anti-PLA2 R antibody,and the positive rate was 51.35%.We found that patients with seropositive antibody had lower serum albumin,higher proteinuria than seronegative(P<0.05).In additional,the patients with seropositive antibody were older than seronegative.No significant differences were found in sex,Scr and e GFR(P>0.05).To analyzed the relationship between anti-PLA2 R antibody and clinical parameters by the linear regression,the results reveals that anti-PLA2 R antibody was different significance correlated with both proteinuria and serum ALB.2.We recruited 166 patients with follow-up characteristics,at a median time of 24 months,including 95 men and 71 women.The positive rate of anti-PLA2 R antibody was 53.01%.All patients received the supportive treatments,62 out of 145 patients got impressive agents treatments(21 of 166 patients without accurate follow-up treatments).Patients with seropositive antibody had lower serum albumin and higher proteinuria than seronegative(P<0.05),the result as the same as the total patients mentioned above.3.68 and 73 of 166 patients with IMN got complete remission and spontaneous remission,respectively.No one was in end stage of renal disease(ESRD).The results analyzed by SPSS19.0 indicated that the complete remission rate and spontaneous remission rate of patients with seronegative antibody were higher than seropositive(52.56 VS 30.68%,P=0.001 and 56.72 VS 44.87%,P=0.02).Kaplan-Meier curve revealed the same results.Adjusted the sex,age,ALB,Scr,proteinuria,treatment and so on,a multivariate Cox analysis revealed that the titer of anti-PLA2 R antibody could be an risk factor that reflected whether patients have reached remission,we found each antibody concentration increased 10 RU/ml,the risk of non-complete remission increased by 54%(P<0.05).We also found that the mean of anti-PLA2 R antibody levels were significantly higher in the active disease group than complete remission and partial remission.There was no significant difference in anti-PLA2 R levels between and partial remission and complete remission groups.Activity disease group was older age,higher proportion of male and higher proportion in patients with receiving immunosuppressive therapy during follow up than complete remission.4.27 patients with follow-up 12 months,we observed the reduction of anti-PLA2 R antibody happened earlier than the decrease in proteinuria.Conclusion: 1.In our center,the positive rate of anti-PLA2 R antibody of patients with IMN was 51.35%.Patients with seropositive antibodies had lower serum albumin,higher proteinuria than seronegative.2.166 patients with follow up for a mean time of 24 months,we found the complete remission rate was 52.56%,spontaneous remission rate was 50.34%,and none of them was in ESRD.Patients with seronegative antibodies of PLA2 R had higher complete remission rate and spontaneous remission rate than seropositive.A multivariate Cox analysis reveals that the titer of anti-PLA2 R antibody could be a risk factor that indicates whether patients have reached proteinuria remission,we found each antibody concentration increased 10 RU/ml,the risk of non-complete remission increased by 54%.3.The reduction of anti-PLA2 R antibody happened earlier than the decrease in proteinuria.That monitoring the changes in anti-PLA2 R antibody assisted in evaluating treatment efficacy. |
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