Meta-analysis Of The Relationship Between M-type Phospholipase A2 Receptor And Its Antibody And The Clinical Manifestation And Prognosis Of Idiopathic Membranous Nephropathy

Objective:To explore the relationship between anti-PLA2 R antibody and the clinic and prognosis of idiopathic membranous nephropathy,we conduct this Meta-analysis.Methods:Based on Meta-analysies of Observational Studies in Epodemiology(MOSE)of observational Studies was designed and written.Relevant studies relationship between PLA2 R and its antibodies and the clinical manifestation and prognosis of idiopathic membranous nephropathy from January 2000 to December 2017 were involved.Electronic databases include Pubmed,EMBASE,MEDLINE,CBM,CNKI and VIP.Meta-analysis was performed by using Revman 5.3 software,and Stata 13.0 softwara was used for biased analysis.Results:16 studies involving 1200 patients were selected for the study(including 894 cases and 306 controls).The result of Meta-analysis showed:1.The relationship between M-type phospholipase A2 receptor and its antibody and the clinical manifestation of IMN patients: Compared with negative group,serum anti-PLA2 antibody positive group had lower serum albumin [SMD =-1.36,95% CI(-2.45,-0.27),P=0.01],higher age [MD=2.76,95%CI(1.97,3.54),P<0.00001],lower e GFR [MD=-10.60,95%CI(-12.38,-8.81),P=0.00001].But there was not statistically significant in 24-hour urine protein [MD =--0.43,95% CI(-2.16,1.30),P = 0.63 ] and serum creatinine [SMD=0.53,95%CI(-0.35,1.41),P=0.24]between serum anti-PLA2 R antibody positive group and the negative group.However,there was no significant difference in serum albumin [MD=-1.50,95%CI(-4.03,-1.02),P=0.24]?age[MD=-1.35,95%CI(-6.51,3.80),P=0.61]?e GFR[MD=-10.60,95%CI(-12.38,-8.81),P=0.00001]?24 hours urine protein[MD=-0.43,95%CI(-2.16,1.30),P=0.63]?serum creatinine [MD=-6.33,95%CI(-16.45,3.80),P=0.22] between renal tissue PLA2 R –positive group and the renal tissue PLA2 Rnegative group.2.The relationship between M-type phospholipase A2 receptor and its antibody and the prognosis of IMN patients: The remission rate of the serum anti-PLA2 R antibody positive group was lower than the negative group [OR=0.48,95%CI(0.30,0.77),P=0.002<0.05];There was no significant difference in remission rate[OR=0.42,95%CI(0.02,8.02),P=0.56] between renal tissue PLA2 R –positive group and the negative group.In serum anti-PLA2 R antibody positive group,the higher titer group had lower remission rate [OR=0.19,95%CI(0.07,0.55),P=0.002<0.05].Comparison of adverse effects rate between anti-PLA2 R antibody positive group and negative group had no significance [OR=1.18,95%CI(0.63,2.21),P=0.61>0.05].The serum anti-PLA2 R antibody titer didn't change the adverse effects rate(OR=1.66,95%CI(0.84,3.29),P=0.14>0.05).Conclusion:1.Compared with negative group,serum anti-PLA2 antibody positive group had lower serum albumin,higher age,lower e GFR,lower remission rate.In serum anti-PLA2 R antibody positive group,the higher titer group had lower remission rate.2.The relationship between PLA2 R in renal tissue and the clinical manifestation and prognosis of IMN patients cannot be ruled out.