| ObjectsA large proportion of patients with diabetes mellitus complicated with proteinuria are diabetic with non-diabetic kidney diseases,of which membranous nephropathy accounts for a large proportion,and serum anti-phospholipase A2receptor(PLA2R)antibody is the specific antibodies of idiopathic membranous nephropathy(IMN).It currently widely used in the diagnosis of idiopathic membranous nephropathy.Whether the diagnostic sensitivity and specificity of this antibody will be affected in patients with diabetes or diabetic nephropathy is currently rarely reported.This study evaluated the significance and value of differential diagnosis of serum anti-PLA2R antibodies in patients with diabetes mellitus combined with different renal pathological types.Content and methodA total of 55 diabetes mellitus inpatients complicated with proteinuria and renal biopsy were enrolled were selected into our group in the Department of Nephrology,Tianjin Medical University General Hospital from May 2016 to March 2018.Patients with diabetes mellitus were divided into three groups according to the pathological results of renal biopsy.diabetic combined with idiopathic membranous nephropathy group(n=36,65.45%),including 7 patients with IMN combined with diabetic nephropathy,diabetic nephropathy(DN)group(n=12,21.82%),diabetic with other glomerulopathies except for membranous nephropathy Group(n=7,12.73%).serum anti-PLA2R antibodies by enzyme linked immunosorbent assay(ELISA)were detected in the three groups,the positive rate of the antibodies in the three groups were compared to evaluate the sensitivity and specificity of serum anti-PLA2R antibody.And the age,sex,duration of diabetes,serum creatinine,and estimated glomerular filtration rate(eGFR),24-hour proteinuria quantification were compared between the three groups using SPSS 20.0 statistical software.ResultsThere was no statistically significant difference in age or duration of diabetes between the three groups(P>0.05).The mean creatinine values of the three groups were(77.05±38.89)umol/L、(96.33±27.60)umol/L、(95.00±30.11)umol/L,respectively.The eGFR were(91.67±23.60)ml/min1.73m~2、(75.58±25.71)ml/min1.73m~2、(81.29±24.18)ml/min1.73m~2,respectively.The 24-hour proteinuria quantification was(5695.61±3009.78)mg/24 hours,(4647.63±2317.89)mg/24hours,(3135.83±1805.06)mg/24 hours.There were no statistically significant differences in serum creatinine(Scr)(p=0.19),estimated glomerular filtration rate(p=0.12)between the three groups.While,there were statistically significant differences in the 24-hour proteinuria between the IMN group and the diabetic with other glomerulopathies except for membranous nephropathy group(p=0.038),the IMN group was higher than those of other nephropathy groups,while there were no significant differences in the IMN group and the DN group,or the DN group and other nephropathy groups.Anti-PLA2R antibody(anti-PLA2R antibody>14Ru/ml indicates positive)positive rate was 80.56%in patients with diabetes mellitus complicated with IMN group,while in the other two groups anti-PLA2R antibody positive rate was 0,and the negative rate was 100%.Anti-PLA2R antibody has a sensitivity of 80.56%and specificity of 100%in the diagnosis of diabetic patients with IMN.The positive detection rate of anti-PLA2R antibody had no significant statistical difference between the patients with IMN(82.76%)or DN combined with IMN(71.43%)(P=0.602).Conclusion1.Serum anti-PLA2R antibody has high sensitivity and specificity in the diagnosis of diabetic patients with IMN;2.DN may followed by varying kinds of podocyte damage,serum anti-PLA2R antibody showed no significant decrease in the sensitivity or specificity of diagnostic IMN in patients with DN;3.There was no significant difference in serum creatinine,estimated glomerular filtration rate between diabetic nephropathy and non-diabetic nephropathy.In summary,serum anti-PLA2R antibody as a laboratory indicator for non-invasive screening of IMN can play an important role in the identification of DN and diabetes with IMN. |
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