| Objective: To investigate the clinical significance of renal tissue PLA2 R expression and serum anti-PLA2 R antibody in patients with idiopathic membranous nephropathy.Methods: To collect all clinical data of idiopathic membranous nephropathy patients who underwent renal tissue PLA2 R and its antibody test in the Department of Nephrology of the First Affiliated Hospital of Fujian Medical University from 2015-10 to 2018-9,including clinical baseline characteristics and follow up data,and analyze the difference of clinical features between anti-PLA2 R antibody positive group and negative group retrospectively,and analyze the difference of clinical features between renal tissue PLA2 R positive group and negative group retrospectively.Result:1.A total of 106 adult patients diagnosed as IMN were recruited to this retrospective study.Among these patients,81 showed anti-PLA2 R antibody expression(76.42%)in anti-PLA2 R antibody positive group while the negative group were 25(23.58%)when underwent renal biopsy.Compared to anti-PLA2 R antibody positive group,patients in negative group were younger(46.44±13.04 years vs 52.98±13.08 years,P=0.031),less Renal c1 q diffuse distribution(24.0% vs 46.3%,P=0.048),lower levels of proteinuria(2.40 [1.41,4.26] g/24 h vs 4.53 [2.60,7.86] g/24 h,P=0.001),higher levels of serum albumin(28.80 [24.40,34.40] g/L vs 23.20 [20.43,27.23] g/L,P=0.001).There was no significance between them regarding gender,natural history,nephrotic syndrome occurrence,smoking,alcohol intake,hemoglobin,serum creatinine,blood urea nitrogen,uric acid.The anti-PLA2 R antibody titer and 24-hour proteinuria had positive correlation(r=0.274,P=0.007),while negative correlation with serum albumin(r=-0.405,P<0.05).2.Compared to anti-PLA2 R antibody positive group,patients in negative group had lower immunosuppressant use(52.00% vs 82.70%,P=0.003)at 6 months after renal biopsy.3.While those who had low anti-PLA2 R antibody titer were found higher spontaneous remission rate and lower immunosuppressant use than those who had high anti-PLA2 R antibody titer(P<0.05).And there were association between antiPLA2 R antibody titer and clinical outcome(r=-0.286,P=0.001).4.Among 81 IMN patients after immunosuppressive therapy for over 6 months,34(41.98%)were considered remission.The induction remission rate of patients with low anti-PLA2 R antibody titer was higher than that of patients with high anti-PLA2 R antibody titer(P<0.05),and Kendall grade correlation coefficient analysis showed that the correlation between anti-PLA2 R antibody titer and patients’ response to immunosuppressive therapy at 6 months was statistically significant(r = 0.230,P = 0.025).5.The area under the ROC curve of anti-PLA2 R antibody titer level for predicting remission events in IMN patients at 6 months was 0.687(95%CI: 0.584-0.789,P=0.001).6.Patients were divided into high titer group and low titer group with serum PLA2 R antibody titer 1:32 as the grouping standard.There is higher 6-month total remission rate in low titer group than high titer group(57.69% vs 27.27%,P<0.05).7.There was no significance between renal tissue PLA2 R positive group and negative group regarding gender,age,24-hour urine protein,serum albumin,serum creatinine,blood urea nitrogen,hemoglobin,total cholesterol,triglyceride,uric acid,serum immune index.8.No significant difference was found between renal tissue PLA2 R positive group and negative group in immunosuppressant use(74.71% vs 78.95%,P=0.925),total remission rate after renal biopsy for 6 months(45.98% vs 26.32%,P=0.116)and total remission rate after immunosuppressive therapy for 6 months(43.08% vs 37.50%,P=0.207).Conclusions:1.Anti-PLA2 R antibody expression was not completely consistent with Renal Tissue PLA2 R expression in IMN patients.2.Anti-PLA2 R antibody titer is associated with disease severity and remission rate.The higher the titer,the worse the condition and the lower the remission rate.3.Renal tissue PLA2 R expression was not associated with disease severity and remission rate. |
PDF Full Text Request