Correlation Between Serum Phospholipase A2 Receptor Antibody Titers And The Diagnosis And Treatment Of IMN

Objective:The correlation between serum phospholipase A2 receptor antibody titer level and the diagnosis and treatment of idiopathic membranous nephropathy was analyzed through cohort study to explore the application value of s PLA2R-Ab in the diagnosis and treatment of idiopathic membranous nephropathy.Methods:1.A historical prospective cohort study was performed by including 89 patients who were admitted to our hospital from November 2017 to November 2018 with renal puncture biopsy,whose pathological diagnosis was IMN,and had indications and willingness to use hormones and immunosuppressants.Among them,61 cases were male(68.5%),28 cases were female(31.5%),the age distribution range was 31-71 years old,the average age was(52.57 ± 11.38)years old.According to the antibody titer of serum phospholipase A2 receptor,35 cases of patients were divided into HTG(high titer group,s PLA2R-Ab?80RU/ml,40%),31 cases of patients were divided into LTG(low titer group,s PLA2R-Ab<80Ru/ml and ?20RU/ml,35%),23 cases of patients were divided into Ng(negative group,s PLA2R-Ab<20RU/ml,25%).Basic clinical data(such as sex,age,serum anti-phospholipase A2 receptor antibody titer,24-hour proteinuria level,serum albumin,serum creatinine,blood urea nitrogen,triglyceride,total cholesterol level,etc.)were recorded.The patients were followed up for 16 months,and the time of CR and PR were recorded.The treatment regimen was hormone combined immunosuppressive therapy(Pred+CTX,Pred+Cs A).Results:1.Analysis of basic clinical data of three groups of patientsAccording to the antibody titer of serum phospholipase A2 receptor,35 cases of patients were divided into HTG(high titer group,s PLA2R-Ab?80RU/ml,40%),31 cases of patients were divided into LTG(low titer group,s PLA2R-Ab<80Ru/ml and ?20RU/ml,35%),23 cases of patients were divided into Ng(negative group,s PLA2R-Ab < 20RU/ml,25%),HTG proteinuria was(13.43±4.47)g/24 h,LTG proteinuria was(9.94 ± 4.23)g/24 h,and NG proteinuria was(6.48±1.69)g/24 h.The quantitative level of HTG proteinuria was significantly higher than that of LTG and NG,and the difference was statistically significant(all P<0.05).The quantitative level of LTG proteinuria was higher than NG,and the difference was statistically significant(P<0.05).(Tab.1)HTG serum albumin was(25.42±3.95)g,LTG serum albumin was(26.85±4.87)g,and NG serum albumin was(29.85±6.50)g.The serum albumin level of NG was significantly higher than that of LTG and HTG(P <0.05),which was statistically significant,but there was no significant difference between LTG and HTG(P>0.05).HTG total cholesterol was(9.85 ± 1.30)mmol/L,LTG total cholesterol was(8.67±1.87)mmol / L,and NG total cholesterol was(6.06 ± 0.95)mmol/L.HTG and NG cholesterol levels were significantly different(P<0.05),which was statistically significant,with no significant differences remaining.Serum creatinine,e GFR,triglyceride,blood urea nitrogen,and six did not show significant differences in clinical basic levels(all P>0.05).2.Analysis of patients' clinical remissionPartial remission:21 cases of HTG patients were partial remission,14 cases of no remission,median remission time was 12 months.27 cases of LTG patients were partial remission,4 cases of no remission,median remission time was 5 months.21 cases of NG patients were partial remission,2 cases of no remission,median remission time was 5 months.The time taken for LTG and NG to reach partial remission was significantly shorter than that for patients in the HTG group.The cumulative partial remission rate of NG was 91%,the partial remission rate of LTG was 87%,and the cumulative partial remission rate of HTG was 60%.The cumulative partial remission rate of HTG was significantly lower than that of LTG and NG,and the difference was statistically significant(P<0.017).There was no statistical difference in the cumulative partial remission rate of LTG and NG(P>0.017).Complete remission: 13 patients had complete remissions in HTG group,22 patients had incomplete remissions,and the median remission time was 12.5 months.21 patients had complete remissions in LTG group,10 patients had incomplete remissions,and the median remission time was 12 months.18 patients had complete remissions in NG group,5 patients had incomplete remissions,and the median remission time was 12 months.There was no significant difference in median response time between the three groups,which may be related to the smaller sample size and higher incomplete response rate.The cumulative complete remission rate of NG was 78%,the cumulative complete remission rate of LTG was 67%,and the cumulative complete remission rate of HTG was 37%.The complete response rate of HTG(high titer group)was significantly lower than that of LTG and NG,and there was a statistical difference(P<0.017).There was no statistical difference between the complete response rate of LTG and NG(P>0.017).3.Influencing factors of remissionUnivariate Cox regression analysis obtained the influencing factors of partial remission and complete remission in IMN patients,and then included all P<0.2 indicators in univariate Cox analysis into multi-factor regression analysis(In clinical work,plasma albumin,24 h proteinuria,and renal function(Scr)are related to patient prognosis,so they will be included in the multivariate regression analysis model).The results show that: The level of s PLA2R-Ab titer and serum albumin level were patients Independent risk factors for partial remission.No independent risk factors related to complete remission were found.Conclusion:1.The 24 h proteinuria level was positively correlated with the titer level.The 24 h proteinuria level was highest in the high titer group,followed by the low titer group,and least in the negative group.Among the three groups of patients,the serum albumin levels in the high-titer group and the low-titer group were significantly lower than those in the negative group,No significant difference was seen between the high and low titer groups.In addition,the total cholesterol level of the high-titer group was higher than that of the negative group,and no significant difference was found.2.In terms of cumulative remission rates,the cumulative partial and complete remission rates of the patients in the high titer group were significantly lower than those in the low titer group and the negative group.There was no significant difference in cumulative remission rates between the negative and low titer groups.It is suggested that patients with high initial s PLA2R-Ab titers have severe clinical symptoms,require long remission time,and have lower sensitivity and remission rate to hormone combined immunosuppressants.At the same time,Cox regression analysis suggested that s PLA2R-Ab titer and serum albumin levels were independent risk factors for partial remission in patients with idiopathic membranous nephropathy,and no independent risk factors for complete remission were found.