| ObjectiveTo study the correlation between glomerular phospholipase A2 receptor(PLA2R)deposition in renal tissue of patients with idiopathic membranous nephropathy(IMN)and their clinical indexes,renal pathological characteristics and curative effect,and understand the relationship between whether there is PLA2 R deposition in glomerulus and its different deposition levels and their clinical indexes,pathological characteristics as well as efficacy,so as to provide some help for the clinical diagnosis and treatment of IMN patients.Methods61 patients with IMN who were pathologically diagnosed by renal biopsy pathology and admitted into the Second Affiliated Hospital of Fujian Medical University in the past five years were selected.All renal biopsy specimens were stained with PLA2 R immunofluorescence.All patients were treated with glucocorticoid and immunosuppressant or conservative regimen,and the follow-up time was more than 48 weeks.The clinical data and renal pathological results were collected at admission,and the changes in 24-hour urinary protein quantification,serum albumin,total cholesterol,triglyceride and serum creatinine were observed in twelfth,24,36 and 48 weeks after treatment.The patients were separated into two groups according to the different expressions of glomerular PLA2 R deposition,which are the group of glomerular PLA2 R positive and the group of glomerular PLA2 R negative.And then the glomerular PLA2 R positive cases were divided into "1 +","2 +" and "3 +" groups according to deposition intensity of PLA2 R.The relationship between clinical indicators,pathological characteristics and efficacys among different groups was compared.Results1 Among 61 IMN patients,47 cases(77.1%)were positive for PLA2 R deposition in glomerulus,and 14 cases(22.9%)were negative.The proportion of male in glomerular PLA2 R positive group was higher than that in glomerular PLA2 R negative group(P<0.05),and there was no significant difference in age,24-hour urine protein,serum albumin,total cholesterol,triglyceride and serum creatinine between the two groups.There was no significant difference in clinical data between renal PLA2 R positive cases with different deposition.The pathological stages in glomerular PLA2 R positive group were mainly stage II and III,while those in glomerular PLA2 R negative group were mainly stage I and II.There was significant difference in pathological stage distribution between the two groups(P=0.003).2 There were no significant differences in the positive rate of glomerulosclerosis,mesangial cell proliferation,mesangial matrix proliferation,renal tubular atrophy,renal interstitial fibrosis,renal interstitial inflammatory cell infiltration,and renal arteriolar sclerosis between the two groups(P > 0.05).The positive rates of renal tubular atrophy,renal interstitial fibrosis and renal arteriosclerosis in "3+" group and "2+" group were higher than those in "1+" group(P < 0.05).The deposition intensity of Ig G and IgG4 in glomerular PLA2 R positive group was higher than that in glomerular PLA2 R negative group,and there was a statistical difference between the two groups(P < 0.05).There was no significant difference in immunofluorescence index positive rate and deposition intensity between renal PLA2 R with different deposition groups.3 The partial remission rate in glomerular PLA2 R negative group was significantly higher than that in glomerular PLA2 R positive group at the 12 th week of follow-up(P=0.004).Among the glomerular PLA2 R positive groups with different deposition,the complete remission rate in "2+" group was higher than that in "3+" group at the 24 th,36th and 48 th week of follow-up(P < 0.001).The partial remissiom rate in "1+" group and "2+" group at 36 th week was significantly higher than that in "3+" group(P <0.05).In IMN patients treated with glucocorticoid combined with tacrolimus regimen,the complete remission rate in glomerular PLA2 R negative group was higher than that in glomerular PLA2 R positive group at the 24 th week and 48 th week follow-up(P <0.05).The partial remission rate in "1+" group was higher than that in "2+" and "3+" groups at 24 th and 36 th W of follow-up(P < 0.05).Conclusion1 There is no significant correlation between PLA2 R deposition in renal tissue and clinical manifestations of IMN patients.2 The expression of PLA2 R in renal tissue is correlated with renal pathological manifestations in IMN patients to some extent.Renal pathological changes were more serious in patients with PLA2 R positive renal tissue.The deposition of PLA2 R in IMN patients is correlated with the expression of Ig G and IgG4 in renal tissue,suggesting that the expression of Ig G and IgG4 plays an important role in the development of IMN.3 The overall effective rate in glomerular PLA2 R negative patients was higher than that in glomerular PLA2 R positive patients.Different levels of PLA2 R deposition in renal tissue are related to the treatment effect of IMN,and those with lower levels of PLA2 R deposition have better curative effects. |
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