| Objective To investigate the relationship between serum anti-PLA2R(M-type phospholipase A2 receptor)antibody and disease condition,disease remission and long-term disease outcome.At the same time,the correlation between serum anti-PLA2 R levels and clinical indicators in patients with idiopathic membranous nephropath(IMN)was analyzed.Methods patients were collected who underwent ultrasound-guided renal biopsy confirmed by renal pathology and electron microscopy as idiopathic membranous nephropathy,from Da Lian City Center Hospital since December 2016 to December 2017.Collect general information,laboratory findings,and treatment plans for patients undergoing renal biopsy.Detection of serum anti-PLA2 R antibody titer by ElISA(enzyme linked immunosorbent assay).The patients were followed up until December 2018,and the follow-up time and treatment plan of the follow-up patients were recorded during the follow-up period.Serum anti-PLA2 R antibody titers were tested at the 1st,2nd,3rd,6th,and 12 th months.regularly test relevant laboratory indicators and record results.The outcomes were defined as complete,partial,and non-remission based on laboratory indicators of response outcome at follow-up.Results A total of 51 patients met the enrollment conditions,the proportion of patients with idiopathic membranous nephropathy was 38.4%(68/177),and the majority of the diseased population was middle-aged(?40 years old)(82.35%).The average age was 52.73±12.1 years,including 30 males and 21 females.the total serum anti-PLA2 R antibody positive rate was 82.4%(56/68)in patients with idiopathic membranous nephropathy,and the median anti-PLA2 R titer was 98.50Ru/ml,51 patients were followed up for at least 12 months,the median follow-up time was 16 months,and serum antibody-positive patients(48 patients)were divided according to the median initial serum antibody titer(91.23 Ru/ml).High titer group and antibody low titer group.Finally,51 patients were followed up for at least 12 months,and serum antibody positive patients(48 patients)were divided into high antibody titer group and low antibody titer group according to the median of initial serum antibody titers.Comparing the clinical baseline values between the two groups at the time of enrollment,the 24-hour proteinuria levels was significantly higher in the high antibody titer group than in the low antibody titer group(P=0.026);the serum total protein levels was significantly lower in the high antibody titer group.There was no significant difference in serum albumin and serum creatinine between the two groups(P=0.122 and P=0.865);serum anti-PLA2 R antibody titer was positively correlated with 24-hour urine protein quantitation(P<0.001).r = 0.536,P < 0.001),and there was no correlation between serum anti-PLA2 R antibody titer and serum albumin(r =-0.227,P = 0.12).According to the different treatment options,it was divided into supportive care and immunosuppressive therapy.At the end of the sixth month,under the supportive care,the total remission rate was significantly higher in the low antibody titer group than in the high titer group(52.9% vs 16.7%).p=0.047).Under immunosuppressive agents,the overall response rate was lower in the low antibody titer group than in the high antibody titer group(100% vs 50%,p=0.047);follow-up to the end of the 12 th month,under the two treatment regimens,the low titer group The overall response rate was higher than the high titer group,but there was no significant difference between the two groups(P=0.241 and P=0.183).By analyzing the changes in the quantitative treatment of urinary protein between the two groups,it was found that the low titer group was better than the high titer group in the supportive care(P=0.006);the long-term follow-up found that the patients in the low titer group the time to complete clinical remission(19.23±1.35 months)was shorter than that in the high titer group(22.59±0.74 months),and the complete response rate in the low antibody titer group was higher than the high antibody titer group and was statistically different(P=0.033).Comparing the changes in antibody titers of the two different treatment regimens,it was found that the antibody titer of the immunosuppressive treatment group decreased faster than the supportive care group.Conclusion Serum anti-M phospholipase A2 receptor antibody titer can reflect the level of immune activity and the severity of the disease in patients with idiopathic membranous nephropathy,and can predict the treatment effect and clinical outcome of patients,which is helpful for the selection of initial treatment options. |
PDF Full Text Request