| Objectives To analyze the level of serum anti-phospholipase A2 receptor(PLA2R)antibody in patients of type 2 diabetes mellitus(T2DM)complicated with proteinuria and its correlation with renal biopsy in the diagnosis of idiopathic membranous nephropathy(IMN)phenomenon,to explore its clinical significance and pathological features and to provide a new diagnostic method for patients with contraindications to renal biopsy.Methods Eighty-seven patients of T2 DM complicated with proteinuria with ultrasounceguided renal biopsy with complete clinical,laboratory and pathological data were selected into our group from January 1,2017 to December 31,2019 in the renal department of the Hebei General Hospital.According to the renal biopsy,the patients were classified into three groups: T2 DM accompanied by IMN group(n=46,including 3patients with IMN combined with DN),diabetic nephropathy(DN)group(n=25),and T2 DM with other types of nephropathy group(n=16).Serum Anti-PLA2 R antibody was detected by enzyme-linked immunosorbent assay.SPSS25.0 software was used to analyze the data.Results 1 There were no statistically significant difference in sex,age,body mass index(BMI),family history of diabetes and diastolic blood pressure(DBP)among the three groups(P>0.05).DN group had a longer duration of diabetes,more patients of diabetic peripheral neuropathy(DPN),more patients with diabetic retinopathy(DR),hypertension,and higher systolic blood pressure(SBP)than IMN group(P<0.05).Compared with the IMN group,the other groups of every index there were no significant difference(P>0.05).Fewer patients with DR were found and SBP were lower in other groups than in DN group(P<0.05).2 There were no statistically significant differences in uric acid(UA),fasting plasma glucose(FPG),microscopic hematuria,Immunoglobulin(Ig)A,Ig M,and complement 4(C4)among the three groups(P>0.05).DN group experienced higher levels of serum albumin(ALB),urea nitrogen(BUN),serum creatinine(Scr),glycosylated hemoglobin A1c(Hb A1c),Ig G(P<0.05)and lower levels of hemoglobin(Hb),estimated glomerular filtration rate(e GFR),triglyceride(TG),total cholesterol(TC),complement 3(C3)than IMN group(P<0.05).There was no statistically significant difference in 24-hour urinary protein quantity(UTP)between IMN group and DN group(P>0.05).Other groups experienced higher levels of ALB,BUN,Scr,Ig G(P<0.05)and lower levels of e GFR,UTP(P<0.05)than IMN group.There were no statistically significant difference in Hb,TG,TC,Hb A1 c,and C3 between IMN group and other groups(P>0.05).Compared with the DN group,the other groups experienced higher levels of C3(P<0.05),there was no significant difference in other indicators(P>0.05).3The positive rate of serum anti-PLA2 R antibody expression was higher in IMN than in DN group and other groups(P<0.001).There was no statistically significant difference in positive expression rate of serum anti-PLA2 R antibody between the DN group and the other groups(P>0.05).4 The most frequent pathological feature in T2 DM patients with proteinuria were IMN(52.87%),followed by DN(28.74%),minimal change disease(6.90%),Ig A nephropathy(5.75%),focal segmental glomerulosclerosis(2.30%),amyloidosis nephropathy(2.30%),and membranoproliferative glomerulonephritis(1.15%).Compared with the IMN group,the DN group experienced lower levels of positive expression rate of Ig G,C3,C1 q,and Fibrin(P<0.05).Compared with the IMN group,the other groups experienced lower levels of positive expression rate of Ig G and C3(P<0.05),there were no significant difference of positive expression rate of C1 q and Fibrin(P>0.05).There was no statistically significant difference of every index between the DN group and the other groups(P>0.05).In the group of DN,stage of Ⅲ were 18(72.00%)which was the most common pathological type of diabetes mellitus,stage ofⅡa were 5(20.00%),and stage of Ⅱb were 2(8.00%).There was no stage of Ⅰ and Ⅳpatients.In the group of IMN with DN,there were respectively 1 cases(33.33%)of stageⅡa,Ⅱb,and Ⅲ.There was no stage of Ⅰ and Ⅳ patients.5 According to the ROC curve,the serum anti-PLA2 R antibody level of 13.80 RU/ml was used as the critical value for diagnosis IMN.The area under ROC curve was 0.904(95%CI: 0.838-0.970),the sensitivity was 0.804,the specificity was 0.951,and the Youden index was 0.756.There was statistically significant difference of serum anti-PLA2 R antibody prediction IMN(P<0.001).6 Spearman rank correlation test revealed that the serum anti-PLA2 R antibody was negatively correlated with ALB(r=-0.462,P=0.001),and positively with UTP(r=0.404,P=0.005).7 Multivariate Logistic regression analysis showed that the duration of diabetes(OR=0.798,95%CI: 0.650-0.979,P=0.030),e GFR level(OR=1.030,95%CI: 1.004-1.056,P=0.024),and positive serum anti-PLA2 R antibody(OR=72.727,95%CI: 11.080-477.372,P<0.001)had statistically significant effects on IMN.DR(OR=50.234,95%CI: 7.199-350.518,P<0.001),SBP level(OR=1.041,95%CI: 1.004-1.079,P=0.030),and positive serum anti-PLA2 R antibody(OR=0.008,95%CI: 0.000-1.131,P=0.010)had statistically significant effects on DN.Conclusions 1 NDRD is very common in T2 DM patients with proteinuria and IMN is the leading cause.2 The sensitivity and specificity of serum anti-PLA2 R antibody are high in patients with T2 DM complicated with proteinuria who are pathologically diagnosed as IMN.3 Short course of diabetes,high level of e GFR,and positive serum anti-PLA2 R antibody are the important clinical influencing factors of IMN.DR,high level of SBP,and negative serum anti-PLA2 R antibody are the important clinical influencing factors of DN.4 Serum anti-PLA2 R antibody has high value in the differential diagnosis of IMN and DN.Renal biopsy should be actively conducted for determining the pathological type in patients of T2 DM with proteinuria without contraindications.Figure 2;Table 11;Reference 152... |
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