| Objective: 1)To evaluate the diagnostic and prognostic value of serum anti-M type phospholipase A2 receptor(PLA2R)antibody,Ig G4 and complement I factor(CFI)detection in children with idiopathic membranous nephropathy(IMN);2)To analyze the efficacy and prognosis of different levels of serum PLA2 in children with idiopathic membranous nephropathy(IMN);3)To investigate the relationship between serum PLA2 R antibody and renal PLA2 R antigen levels and idiopathic membranous nephropathy in children,so as to further understand the relationship between serum anti-PLA2 R antibody and renal PLA2 R antigen.Methods: 1)40 cases of IMN,38 cases of secondary membranous nephropathy(SMN),and 36 cases ofminimal lesions nephropathy(MCD)were selected from the pediatrics department of Xinjiang Autonomous Region People's Hospital in August 2013 and April 2018.At the same time,40 healthy children were selected for physical examination during the same period to compare the serum levels of anti-PLA2 R antibody,Ig G4 and CFI in each group.The differences of serum albumin(Alb),24 h urine protein(24h TP),serum creatinine(Scr),hemoglobin(Hb),total cholesterol(TG),glomerular filtration rate(e GFR)and other serological indexes in the anti-PLA2 R antibody,Ig G4 and CFI positive group and negative group of IMN children,as well as the remission rate and prognosis after 6 months of treatment were analyzed;2)Select the xinjiang autonomous region people's hospital and children's hospital of urumqi city in August 2013 to April 2018 confirmed 114 cases of children with idiopathic membranous nephropathy(IMN),using indirect immunofluorescence method,serum levels of PLA2 R IMN children can be divided into positive group(PLA2R express positive),negative(PLA2R express negative),comparing the two groups during the 12 months of treatment for 24 h urine protein(24h-UP),serum albumin(propagated),serum creatinine(Scr),total effective rate and draw two groups of patients with effective relief time curve.Scatter plots of serum anti-PLA2 R antibody and changes in Alb,Scr and 24 h UP were drawn to analyze the correlation,and ROC curve was drawn to analyze the predictive value of serum PLA2 R level for 12-month remission events in IMN children;3)Eighty-six children with IMN confirmed in pediatrics department of Xinjiang Autonomous Region People's Hospital in January,2013 and December,2018 were selected.The serum anti-PLA2 R antibody level of the children was determined by elisa,and the PLA2 R antigen,Ig G,Ig G1 and Ig G4 of the kidney of the children were determined by immunofluorescence.Expression of C1 q,C3 and C4 in renal tissue.Serum albumin(Alb),24 h urine protein(24h TP),serum creatinine(Scr),hemoglobin(Hb),total cholesterol(TG),glomerular filtration rate(e GFR)and other serological indexes were detected.Results: 1)Among the 154 subjects,36(23.4%)had positive serum anti-PLA2 R antibody,all of whom were children in the IMN group.Thirty-six patients(23.4%)were positive for Ig G4,and 34(85.0%)were in the IMN group.Thirty-eight patients(24.7%)had positive serum CFI,and 33 patients(82.5%)in the IMN group had positive serum CFI.The comparison of serum anti-PLA2 R antibody between the positive group and the negative group of IMN children showed statistical differences in serum albumin,urine protein,remission rate at 6 months of treatment,and end point events(P<0.05),and the comparison results between Ig G4 and CFI positive group and negative group were similar to anti-PLA2 R antibody;2)The positive rate of serum PLA2 R antibody in 114 children with IMN was 67.54%.24 h UP and Alb white were higher in the positive group than in the negative group at 3,6,9 and 12 months after treatment,and the 24 H-UP albumin levels in the children with different titers of PLA2 R were statistically significant.The overall effect of negative group was better than that of positive group(P<0.001).The total effective rate of the negative group was 100%,significantly higher than that of the positive group(71.43%,P<0.001).The serum anti-PLA2 R antibody level was negatively linearly correlated with serum Alb change(r=-0.853,P<0.001)and 24 h UP change(r=-0.769,P<0.001),but not with serum Scr change(r=0.132,P=0.162).The area under ROC curve of serum PLA2 R antibody titer level was 0.79,and the prediction sensitivity and specificity were 91.7%and 58.3%,respectively,when the serum PLA2 R antibody titer was 1:32.The ROC curve analysis showed that the area under the curve of remission events in the anti-im N patients with PLA2 R was 0.814,the cut-off value was 65.57RU/m L,and the sensitivity,specificity and accuracy were 0.700,0.881 and 0.794;3)Among the 86 subjects,63(73.25%)were positive for ANTI-PLA2 R antibody and 80(93.02%)were positive for PLA2 R antigen in renal tissue.Serum anti PLA2 R antibody positive group and renal tissue PLA2 R antigen positive and negative serum albumin levels,24h-UP level change is statistically significant(P<0.05),different drops of serum PLA2 R level and kidney tissues of PLA2 R positive rate,rate of positive of Ig G4,C1 q positive and its pathological staging and there were no statistically significant differences in the proportion of the segmental sclerosis.The expression of C1 q,C3 and C4 in renal tissue suggests that complement activation may be involved in the pathogenesis of IMN,and the activation of classical,MBL and bypass pathways may be involved in the pathogenesis of IMN.Conclusion: 1)Serum anti-PLA2 R antibody,Ig G4 and CFI tests play an important role in the differentiation and diagnosis of IMN.The treatment remission rate and the proportion of no endpoint event occurred in the patients with anti-PLA2 R antibody,Ig G4 and CFI negative IMN patients are higher;2)The serum PLA2 R antibody level has a great influence on the clinical treatment effect of IMN children.The recovery range of serum Alb and 24 h UP in negative patients is larger,and it is linearly negatively correlated with the serum anti-PLA2 R antibody level,and the total effective rate is relatively higher.Serum anti-PLA2 R antibody level can be used as an indicator for diagnosis,clinical treatment and prognosis of IMN children;3)Serum PLA2 R antibodies and kidney tissues PLA2 R antigens for the diagnosis of IMN has great significance,especially in the kidney tissue PLA2 R antigen for diagnosis are more sensitive to IMN,serum anti PLA2 R antibodies and kidney tissues PLA2 R antigen combination will greatly improve the diagnostic rate of IMN,for serum anti PLA2 R antibodies and kidney tissues PLA2 R antigen were negative for children with IMN,kidney tissues Ig G4 expression,also added IMN diagnosis.Serum anti-PLA2 R antibody is more effective than renal tissue ANTI-PLA2 R antigen in reflecting the clinical severity of IMN children.PLA2 R antigen levels in renal tissue can also indicate clinical severity the disease,but not did they correlate with pathological severity of the kidney. |
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