The Expression And Significance Of PLA2R And TSHD7A In Idiopathic Membranous Nephropathy

Objective: This paper tries to investigate the expression and significance of serum anti-phospholipase A2 receptor(PLA2R)antibody,renal tissue PLA2 R,thrombospondin type 1 domain containing 7A,(THSD7A),IgG subtype and complement in idiopathic membranous nephropathy(IMN).Methods: Retrospective analysis: 60 patients with IMN proven by kidney biopsy at ya ’an people’s hospital from January 2015 to February 2019 were enrolled.The total positive rate and the positive rate under different clinical condition of PLA2R-AB were explored.Prospective study: 74 patients with glomerulopathy confirmed by kidney biopsy at ya ’an people’s hospital from January 2015 to February 2019 were enrolled and divided into IMN and non-IMN groups according to their clinical diagnosis.The laboratory parameters of all the patients were collected.Quantitative enzyme-linked immunosorbent assay(ELISA)was used to detect PLA2R-AB titer.Immunofluorescence(IF)was used to detect the fluorescence intensity of renal PLA2 R,THSD7A,IgG subtype and complement.The sensitivity and specificity of PLA2R-AB,the correlation between PLA2R-AB titer and laboratory parameters and the expression and significance of renalPLA2 R,THSD7A,IgG subtype and complement of IMN patients were evaluated.Results:(1)total positive rate of PLA2R-AB was 35% in IMN.Whereas,the positive rate in patients who did not receive immuno-suppression therapies,24 hUPro > 2g or Alb <30g/L was higher than the counterpart.(2)The sensitivity and specificity of PLA2R-AB were 52.78% and 97.36%.The area under ROC curve of PLA2 R was 0.895.(3)PLA2R-AB titer and positive rate of IMN group were significantly higher than those of non-IMN group(P<0.01).Within the IMN group,the PLA2R-AB titer was significantly correlated with 24hUPro(r = 0.578,P = 0.000).Baseline 24 hUPro of IMN group with positive PLA2R-AB was higher than negative(P < 0.05).(4).The sensitivity of PLA2 R,IgG4 and THSD7 A was 80.56%,91.67% and 5.56%,respectively,and the specificity was 100%,94.74%and 100%,respectively.Remarkably,GlomerularPLA2 R and THSD7 A were co-positive in 2 of 36 IMN patients.The fluorescence intensity of IgG4 was significantly higher than that of IgG1(P < 0.01).No one showed positive C1 q.Conclusion: The positive rate of PLA2R-AB in IMN patients is affected by immunosuppressive therapy and disease activity.The anti-PLA2 R antibody plays an important role in the diagnosis,antidiastole and monitoring the disease activity of IMN.In terms of the sensitivity to the diagnosis of IMN,the glomerular IgG4 subtype is higher than the renal tissue PLA2 R antigen,which is higher than the PLA2 R antibody.THSD7 A,another pathogenic target antigen of IMN,can coexist with PLA2 R in the same patient.Detecting both PLA2 R and its antibodies may increase the diagnostic accuracy of IMN.Combined detection of renal PLA2 R,THSD7A and IgG4 contributes to the diagnosis and antidiastole of IMN.