Combined Assessment of Phospholipase A2 Receptor Autoantibodies and Glomerular Deposits in Membranous Nephropathy
Combined Assessment of Phospholipase A2 Receptor Autoantibodies and Glomerular Deposits in Membranous Nephropathy
复制标题
膜性肾病中磷脂酶 A2 受体自身抗体和肾小球沉积物的联合评估。
DOI：
10.1681/asn.2015080953
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发表时间：
2016-10-01
影响因子：
13.6
通讯作者：
Liu, Zhi-Hong
中科院分区：
文献类型：
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作者：
Qin, Hua-Zhang;Zhang, Ming-Chao;Liu, Zhi-Hong
在特发性膜性肾病（IMN）中观察到血清磷脂酶A2受体抗体（SAbs）和肾小球磷脂酶A2受体抗原（GAg）沉积。然而，这两种生物标志物的临床应用，特别是GAg沉积，需要进一步评估。我们在572例经活检证实的IMN患者中用ELISA法测定SAb浓度，用免疫荧光法测定GAg沉积。总体而言，68.5%的患者（392/572）可检测到SAb（SAb+），98.7%的SAb+患者（387/392）和70.6%的SAb-患者（127/180）存在GAg沉积（GAg+）。与SAb-/GAg+患者相比，SAb+/GAg+患者的蛋白尿水平更高（P<0.001），蛋白尿缓解的机会更低（P<0.001）。在52例接受重复活检的患者中，未达到缓解的患者在首次活检时的SAb+率高于达到缓解的患者（P=0.001）。此外，SAb+水平在未达到缓解的患者中持续存在，但在第二次活检时达到缓解的患者中显著降低。未达到缓解的患者首次活检GAg+率也高于达到缓解的患者（P<0.01）。持续的GAg+沉积与疾病复发相关。总之，结合SAb水平的测量和GAg沉积的检测可以提供关于IMN患者的诊断、治疗反应和疾病复发的额外信息。
Serum phospholipase A2 receptor antibodies (SAbs) and glomerular phospholipase A2 receptor antigen (GAg) deposits have been observed in idiopathic membranous nephropathy (IMN). However, the clinical application of these two biomarkers, particularly GAg deposition, needs to be further evaluated. We measured SAb concentration by ELISA and GAg deposition by immunofluorescence in 572 patients with biopsy-proven IMN. Overall, 68.5% of patients (392 of 572) had detectable SAb (SAb+), and 98.7% of patients who were SAb+ (387 of 392) and 70.6% of patients who were SAb- (127 of 180) had GAg deposition (GAg+). Compared with patients who were SAb-/GAg+, patients who were SAb+/GAg+ exhibited higher levels of proteinuria (P<0.001) and a lower chance of proteinuria remission (P<0.001). In 52 patients who underwent repeat biopsies, patients who did not achieve remission had a higher SAb+ rate on the first biopsy than patients who went into remission (P=0.001). Furthermore, SAb+ levels persisted in patients who did not achieve remission but significantly decreased in patients who achieved remission by the second biopsy. Patients who did not achieve remission also had a higher GAg+ rate on the first biopsy than patients who achieved remission (P<0.01). Sustained GAg+ deposits correlated with disease relapse. In conclusion, combining the measurements of SAb levels and detection of GAg deposition may provide additional information regarding diagnoses, treatment response, and disease relapse in patients with IMN.