Expression And Significance Of Phospholipase A2 Receptor And Thrombospondin Type-1 Domin-containing 7A In Idiopathic Membranous Nephropathy

Objective:Membranous nephropathy(MN)is more common in adult nephrotic syndrome,especially in middle-aged and elderly people,and its incidence in chronic kidney disease is increasing day by day.Since 2009,the two most important target antigens for IMN,PLA2 R and THSD7 A,have been discovered one after another.Although the research on IMN is getting hotter and hotter,the specific pathogenesis of IMN remains unclear.The aim of this research:1.To ascertain PLA2 R,THSD7A in nephridium organizes,To appraise the conveyance and significance of two markers in Idiopathic membranous nephropathy(IMN).2.To detect the levels of PLA2 R antibody and THSD7 A antibody in serum,To evaluate the expression and significance of two markers in IMN.Methods:1.176 cases of membranous nephropathy diagnosed by renal biopsy from2017.02-2017.10 were opt.The expression of G-PLA2 R,G-THSD7 A and G-Ig G4 and deposition sites in MN patients were detected by immunohistochemical method(IHC).,Combined with clinical data(sex composition,age,number of patients with hypertension,urine protein quantitation(24h UPro),serum albumin(Alb),serum creatinine(SCr),estimated glomerular filtration rate(e GFR,CKD-EPI formula),renal insufficiency,serum urea nitrogen(BUN),total cholesterol(TC),triglyceride(TG),cystatin C(Cys C),α1 microglobulin(α-MG),β2 micro Globulin(β2-MG),microscopic hematuria)and pathological features(immunofluorescence Ig G,C3 expression intensity,immunohistochemical Ig G4 expression rate),the use of ROC curve to evaluate its diagnostic value in IMN and its correlation with clinical indicators.2.Select 41 cases of membranous nephropathy diagnosed by renal biopsy from 2017.02 to 2017.10,and use ELISA to detect the levels of S-PLA2 R and S-THSD7 A one by one,and combine the expression of related glomerular antigens to evaluate the diagnosis of joint detection in IMN.significance.3.Use statistical methods,measurement data to indicate that the two groups used t test.The count data is expressed in terms of incidence(composition ratio),and comparison of sample rates is tested.The sensitivity,specificity,and ROC curve were used to evaluate the value of PLA2 R,Ig G4,and THSD7 A in the differential diagnosis of IMN.Results:1.176 cases of patients diagnosed as MN by clinical and pathological(LM,IF,EM)were included in our institute’s Institute of Nephrology from 2017.02 to 2017.10,including 106 males and 70 females,with an average age of 47.47±13.40 years.In the IMN group,153 cases(86.9%)were male,95 males and 58 females,with an average age of 49.26±12.47 years;2.IHC detection of IMN patients in 176 cases of MN patients G-PLA2 R positive deposition rate was 56.2%,G-THSD7 A positive deposition rate was 4.6%,and found 3cases PLA2 R,THSD7A double positive;3.ELISA detection of 36 cases of IMN,S-PLA2 R positive rate of 69.4%,G-PLA2 R positive rate of 72.2%,S-THSD7 A positive rate of 5.6%,G-THSD7 A positive rate of5.6%;4.The positive rate of G-Ig G4 in 69.8% of the IMN G-PLA2 R group was 69.8%,and the G-Ig G4 positive rate in the G-THSD7A-positive group was 85.7%.5.Detection of G-PLA2 R and G-THSD7 A expression in 153 IMN groups and combined detection of PLA2R+Ig G4 and THSD7A+Ig G4 for the diagnosis of IMN were 56.2%,4.6%,39.2%,3.9%,respectively.The specificities were 65.2%,100%,78.3%,100%;6.According to G-PLA2 R positive and negative groups,the clinical and pathological features of 81 IMN patients were compared.There were statistically significant differences in the number of microscopic hematuria(clinical characteristics)between the two groups,and the rest was not statistically significant;According to the positive and negative groups of THSD7 A,there was no statistically significant difference in each index.Conclusion:1.The glomerular PLA2 R antigen and serum PLA2 R antibody have a positive expression rate in IMN(72.2%,69.4%),which is a specific diagnostic index of IMN,and combined detection with glomerular Ig G4 can improve the diagnosis rate;2.The glomerular THSD7 A antigen and serum THSD7 A antibody have certain expression rate and high specificity in IMN,but their expression rate is very low,which can be used as a specific diagnostic indicator of IMN supplementation.And the renal tissue THSD7 A is mostly expressed in the PLA2R-negative IMN patients in the renal tissue and can also be expressed in PLA2R-negative IMN patients in the renal tissue.