The Study Of The Correlations Between Serum Anti-PLA2R Antibody And Clinicopathological Features And Curative Effects In Adults With Idiopathic Membranous Nephropathy

【Background and Objectives】The results are different about the correlations between the levels of serum anti-PLA2 R antibody(sPLA2R-Ab)and clinical manifestations,pathological changes and curative effects in patients with idiopathic membranous nephropathy(IMN).Whether sPLA2R-Ab can guide the treatment of patients with IMN is uncertain.The purpose of this study mainly includes the following points:1.Investigating the correlations of the levels of sPLA2R-Ab and clinical manifestation,pathological changes and risk classiffication in patients with IMN.2.Analyzing the correlations between the levels of sPLA2R-Ab and therapeutic effects,mainly discussing that in the patients who were treated with glucocorticoid combined with tripterygium wilfordii(TW).【Methods】We detected the levels of sPLA2R-Ab by indirect immunofluorescence assay in 78 patients with IMN at the time when they were going to accept renal biopsies and never received treatment of immunosuppressive agents before.Then we analyzed the correlations of sPLA2R-Ab and clinical manifestations,pathological changes and risk classiffication.According to the 24-hour urinary protein and renal function,the risk classiffication was divided into low risk,medium risk and high risk.There were75 patients who were followed up for ≥6months with standard treatment.The following items were observed and recorded after the treatment of the first month 、 the third month、and the sixth month:24-hour urinary protein,blood routine,liver function,serum creatinine and side effects.All their statistics were complete.Analyzing the correlations between the levels of s PLA2R-Ab and treatment outcomes.【Results】1.In the 78 patients with IMN,54 patients displayed sPLA2R-Ab positive and 24 patients showed negative(69.2%and30.8%,respectively).The sPLA2R-Ab positive group was older in age,higher in proportion of microscope hematuria,lower in eGFR,higher in IgG4 positive rate and more stronger intensity of IgG4,compared with the negative group,the above clinical indices between the two groups were statistically different(p<0.05).There was no difference on serum creatinine,serum albumin,pathological stages,mesangial cell proliferation and mesangial matrix proliferation,glomerular sclerosis,and the incidence of renal tubular atrophy,renal interstitial fibrosis,renal arteriosclerosis between the sPLA2R-Ab positive group and sPLA2R-Ab negative group.There was no correlation between the levels of sPLA2R-Ab and the risk classiffication of IMN.The complete remission rates of the two groups increased with extended follow-up time.The complete remission rates of the third month and the effective rates of the sixth month between two groups were statistically significant(P<0.05).2.When divided by sPLA2R-Ab titres,there was no difference in clinical indicators and pathological features among 1:10、1:32、1:100 groups.Followed up for 6 months,the effective rates showed a sharp decline with the elevated sPLA2R-Ab titres.The complete remission rates and the effective rates were no difference among different titres at the same time.3.In the nephrotic syndrome subgroup,no statistical difference was found in various clinical indexes between sPLA2R-Ab positive group and sPLA2R-Ab negative group.But the positive rates of IgG、IgG4 were higher and the intensity of IgG4 was stronger in the sPLA2R-Ab positive group than the negative cases(P<0.05).The rest pathological changes did have nothing to do with the levels of sPLA2R-Ab.In the subgroup with patients who didn’t present as nephrotic syndrome,the sPLA2R-Ab positive group was higher in urine red cell count,24-hour urine protein quantity and blood uric acid,higher percentage in renal interstitial inflammatory cell infiltration and stronger intensity in IgG4 than sPLA2R-Ab negative cases(P<0.05).There was no difference in the other clinical indexes and pathological changes between the two groups.4.The curative effects of cases treated with glucocorticoid combined with TW were better in sPLA2R-Ab negative group than sPLA2R-Ab positive group.Both of them presented increasing trends on complete remission rates during the follow-up period,except for the sixth effective rates which showed statistically different compared with each other(P=0.045).【Conclusion】1.There are certain correlations between the levels of sPLA2R-Ab and clinicalpathological characteristics in adult with IMN.Compared with sPLA2R-Ab negative group,the positive group is more serious.In nephrotic syndrome subgroup,the levels of sPLA2R-Ab is no relation with clinical indexs and pathological changes,except for the positive rate of IgG,IgG4 and the intensity of IgG4.Those who present as non nephrotic syndrome,there are certain correlations between the levels of sPLA2R-Ab and clinical features and pathological changes.But our data show that the levels of sPLA2R-Ab has nothing to do with the IMN risk assessment stratify.2.The curative effects of sPLA2R-Ab positive group are better than the negative cases,different sPLA2R-Ab titres make no difference on therapeutic effects.Patients with IMN treated with glucocorticoid combined with TW showed significant curative effects and less side effects in short-term.This strategy is appropriate for patients with IMN,especially for the sPLA2R-Ab negative cases.The detection of sPLA2R-Ab can help predict the treatment effects of patients with IMN.