| Objective:To explore the clinical value of phospholipase A2 receptor(PLA2R),thrombospondin type 1 domain containing 7A(THSD7A)and their antibodies in the diagnosis and treatment response predictionof idiopathic membranous nephropathy(IMN).Methods:From January 2017 to February 2020,121 patients with glomerular disease diagnosed by renal biopsy in Ya’an people’s hospital were selected.According to clinical and pathological examination,the patients were divided into IMN group,SMN group and non-MN group.The titers of serum anti-PLA2R and anti-THSD7A antibodies were measured by enzyme-linked immunosorbent assay(ELISA),and the expressions of glomerular PLA2R,THSD7A,immunoglobulin and complement were detected by immunofluorescence assay(IF).The clinical and pathological data of the patients were collected,and the patients with IMN were followed up.The serum anti-PLA2R antibody titers,quantitative test of 24-hour urinary protein(24hUPro),Serum albumin(Alb)and other laboratory indicators were dynamically monitored.To evaluate the diagnostic value of PLA2R,THSD7A and their antibodies to IMN,analyze the correlation between the titers of serum anti-PLA2R,anti-THSD7A antibodies and clinical activity of disease,evaluate the value of PLA2R and its antibody for predicting therapeutic response.Result:(1)The positive rates of serum anti-PLA2R antibody in IMN,SMN,and non-MN were 60.34%,5.88%,and 0%,respectively(P<0.05).The sensitivity and specificity of serum anti-PLA2R antibody for the diagnosis of IMN were 60.34%,98.41%,and the area Area under the receiver operating characteristic curve(AUCRoc)was 0.864.The positive rates of serum anti-THSD7A antibody in IMN,SMN and non-MN were 5.17%,0%,8.70%,respectively.(2)There was a negative correlation between baseline serum anti PLA2R antibody and serum Alb in patients with IMN[[r=-0.384,(P=0.01 1)].(3)24h Upro in the first and third month after treatment in the positive group was higher than that in the negative group(P<0.05),but there was no significant difference in 24h Upro and serum Alb between the two groups(P>0.05).(4)At the 1st,3rd and 6th month after treatment,the remission rate of the negative group of serum anti PLA2R antibody was higher than that of the positive group(P<0.05),while there was no statistical difference between the two groups at the 12th month(P>0.05).However,the remission time of the serum anti PLA2R antibody positive group was 6(3,11)months longer than that of the negative group 3(1,5)months(P<0.05).(5)The sensitivity of glomerular PLA2R and THSD7A in the diagnosis of IMN was 81.03%,6.90%,and the specificities were 100%.(6)The serum creatinine(Scr)in the glomerular PLA2R positive was higher than those in the negative group(P<0.05),and the pathological stages were mainly stage II and stage II-III(P<0.05),but there was no statistical difference in the remission rate between the two groups after 12 months of follow-up(P>0.05).Conclusion:Serum anti PLA2R antibody is not only helpful for the diagnosis and differential diagnosis of IMN,but also can reflect the disease activity of IMN patients,to some extent,it can predict the therapeutic effect and prognosis.The sensitivity and specificity of glomerular PLA2R antigen in the diagnosis of IMN patients are higher than that of serum anti-PLA2R antibody.The combination of the two is more helpful for the identification of IMN.PLA2R antigen deposition in glomeruli may be related to the severity of the disease.THSD7A and its antibody are also of great value in the diagnosis of IMN,but the correlation between serum THSD7A antibody and disease activity remains to be further studied.There were PLA2R and THSD7A double antigen positive patients in IMN. |
