| Objective:1.To investigate the relationship between the serum anti-phospholipase A2 receptors(PLA2R)antibodies and clinical high incidence of thrombosis in patients with idiopathic membranous nephropathy(IMN);2.To investigate the pathological characteristic of kidney tissue in IMN,the relationship between the expression of PLA2 R,the deposition of immune complex and serum antibody;3.To investigate the clinical risk factor for a high incidence of thrombosis in IMN.Methods:1.Patients: 65 patients admitted to the Renal department of Henan University First Affiliated Hospital between January 2015 and June 2016,and diagnosed as biopsy-proven IMN by light microscope,electron microscope and immunofluorescence.2.Data collection: the kidney biopsy specimens were paraffin embedded,and sliced to detect the deposition of IgG classes,PLA2 R expression and so on by immunohistochemical staining,at the same time to observe their deposition characteristics in renal tissue,and analyz the results with semi-quantitative analysis by image analysis system.The latest clinical data before renal biopsy were collected from the medical records,including the parameters of blood routine,serum albumin,cholesterol,triglycerides,serum creatinine,prothrombin,fibrinogen and thrombin time,D-dimer,24 hours urinary protein level,The titer of anti PLA2 R antibodies on the biopsy was detected,using enzyme-linked immunosorbent assay.Patients received a routine examination blood vessel after admitted to hospital,to evaluate the thrombus,A chest CT examination was performed to the patients who have respiratory symptoms such as chest tightness,and dyspnea,and when it is necessary,the lung ventilation perfusion scan was used to clear the presence of pulmonary thrombosis.Results:1.In all the patients with IMN,the serum anti PLA2 R antibodies positive rate was 81.5%,there are 10 patients accompanying with thrombosis,the incidence of thrombosis in all the patients with IMN was 15.4%,including 6 lower limb venous thrombosis,2 place for pulmonary embolism,and 4 renal vein thrombosis,both for venous thromboembolism,while no arterial thrombosis was found.The circulating anti-PLA2 R antibody was detectable in 53 patients.Among them,thrombosis occurred in 10 of them,while in the 12 patients without anti-PLA2 R antibody,none of them had thrombosis(18.9% vs.0%,P=0.034).The age of antibodies positive group and negative group were comparable(48.58 ± 48.58 vs 43.92±9.11 years,P=0.36).2.The median level of 24-hour urinary protein of patients with positive anti-PLA2 R antibody was 6.05 g/24 h,which was significantly higher than that of patients without anti-PLA2 R antibody(6.05,3.3-9.85 vs.2.53,2.1-4.82 g/24 h,P=0.002).The serum albumin was also significantly higher in patients with anti-PLA2 R antibody than that of patients without anti-PLA2 R antibody(25.88±4.68 vs.30.45±4.90 g/L,P=0.004).There was no difference of serum creatinine,cholesterol and other clinical parameters between patients with and without anti-PLA2 R antibody.3.The patients with anti-PLA2 R antibody presented with advanced Churg’s stage of MN,with 18 patients of stage I,29 patients of stage II and 6 patients of stage III.While no patients without anti-PLA2 R antibody presented with stage III(P=0.025).The IgG1 and IgG4 deposition were predominant in 15.2% and 87.0% patients with anti-PLA2 R antibody.Patients without anti-PLA2 R antibody also showed a similar Ig G1 and IgG4 predominant deposition and there was no difference between them.4.Among the patients with anti-PLA2 R antibody,thrombosis occurred in 10 of them.The 24-urinary protein level of patients with thrombosis was significantly higher than that of patients without thrombosis(9.19,7.83-11.23 vs.5.38,3.03-8.40,P=0.008).And the median D-dimer level of patients with thrombosis was 1.135 mg/L,which was significantly higher than that of patients without thrombosis(1.135,0.235-3.302 vs.0.16,0.09-0.36 mg/L,P=0.004).However,the level of anti-PLA2 R antibody was comparable between patients with and without thrombosis,and also the other parameters.Conclusion:There were higher incidence of thrombosis and more severe clinical manifestations in patients with positive circulating PLA2 R antibody than that of patients without anti-PLA2 R antibody,the anti PLA2 R antibodies maybe pathogenic;The high incidence of thrombosis in IMN correlated to the occurrence of serum PLA2 R antibodies,but no obvious correlation with the level of antibody was found;... |
PDF Full Text Request