An Analysis Of Idiopathic Membranous Nephropathy's Clinical Characteristics Based On Different Expressions Of Serum Anti-PLA2R Antibody And Glomerular PLA2R Deposition

ObjectiveIn this paper,the correlation of serum anti-phospholipase A2 receptor?PLA2R?,clinical indexes and renal pathological characteristics was analyzed to explore the effect of serum anti-PLA2R antibody in different concentration groups on patients with IMN.In addition,the influence of different expressions of PLA2R serum antibody and glomerular PLA2R deposition on patients with IMN reflected in clinical performances and renal pathology was also studied,so as to provide valuable guidance for the clinical diagnosis and treatment of IMN patients.MethodsIn total,69 patients proven IMN under renal pathological light microscopy,electron microscopy and immunofluorescence,and simultaneously performed serum anti-PLA2R antibody concentration measurement after percutaneous renal biopsy from January 1^st,2015 to January 1^st,2019 from Second affiliated hospital of fujian medical university were selected.The patients were divided into three groups based on serum anti-PLA2R antibody concentration level.17 patients were in the negative group with serum anti-PLA2R antibody concentration<20.00RU/ml.The low concentration group included 26 patients with serum anti-PLA2R antibody concentration was within 20.00⁹1.65RU/m.And 26 patients were in the high concentration group in which serum anti-PLA2R antibody concentration was 91.65⁴66.80RU/ml.Besides,the patients were separated into four groups according to the different expressions of serum anti-PLA2R antibody and glomerular PLA2R deposition:5 patients in double negative group;12 patients in the group of negative serum and positive glomerular;7 patients in the group of positive serum and negative glomerular and 45 patients in double positive group.There was a comparative analysis between groups about IMN patients'clinical performances and renal pathology,so as to further assess the effect of different expressions of PLA2R serum antibody and glomerular PLA2R deposition on IMN patients'clinical characteristics.ResultsThe serum anti-PLA2R antibody of the 69 patients was positively correlated with24-hour urinary protein quantification?r=0.302,P=0.012?,cholesterol?r=0.251,P=0.038?,low-density lipoprotein?r=0.369,P=0.02?and was negatively correlated with alanine aminotransferase?r=-0.265,P=0.028?.The concentration of serum anti-PLA2R antibody in female patients was higher than that in male patients,P<0.05.There were statistically significant differences in 24-hour urinary protein quantification,cholesterol and low-density lipoprotein in the three groups with different serum anti-PLA2R antibody concentration levels,which were mainly reflected in the negative group and the positive group,while there was no significant difference between the low concentration group and the high concentration group.Women were more common in the high concentration group,while men were more common in the negative group and the low concentration group,and the differences were statistically significant.The positive rate of serum anti-PLA2R antibody was 75.3%,and the positive rate of glomerular PLA2R deposition was 82.6%.The co-positive rate was 65.22%.The expression of serum anti-PLA2R antibody was positively correlated with glomerular PLA2R deposition,IgG4 and deposition intensity of complement C3?P<0.05?.There were inter-group differences in renal pathological staging,IgG,IgG4 and deposition intensity of complement C3 between the groups with different expressions of serum anti-pla2r antibody and glomerular PLA2R deposition.Conclusion1 The level of serum anti-PLA2R antibody concentration in female patients with IMN was higher than that in male patients.Since there is possibility of gender difference in the expression of serum anti-PLA2R,it is necessary to pay attention to gender difference when incorporating anti-PLA2R antibody into clinical observation indicators.2 To some extent,the expression of serum anti-PLA2R antibody can reflect the level of urinary protein in IMN patient.However,the antibody concentration of patients with positive expression for this antibody has no significant influence on the urinary protein level of IMN patients.3 With the higher concentration of serum anti-PLA2R antibody,the expression of PLA2R antigen and the deposition of IgG4 and C3 in glomerular are more serious,suggesting that the expression of PLA2R antigen,IgG4 and complement C3 in glomerular plays an important role in the occurrence and development of PLA2R-related IMN.4 The different expressions of PLA2R serum antibody and glomerular PLA2R deposition were correlated with renal pathological stages,IgG,IgG4 and C3 deposition intensity.