Circulating antibodies against M-type phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A in Chinese patients with membranous nephropathy
Circulating antibodies against M-type phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A in Chinese patients with membranous nephropathy
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DOI：
10.1007/s11255-019-02146-w
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发表时间：
2019-08-01
影响因子：
2
通讯作者：
Qiu, Yurong
中科院分区：
文献类型：
--
作者：
Tian, Caixia;Li, Lian;Qiu, Yurong
背景：M型磷脂酶A2受体(PLA2R)和凝血酶敏感蛋白-1结构域7A(THSD7A)最近被确定为特发性膜性肾病(IMN)患者的靶抗原。MN患者血清中PLA2R和THSD7A的患病率值得进一步研究。方法我们研究了212例经活检证实的IMN、118例继发性膜性肾病和84例其他肾脏疾病患者血清中抗PLA2R和抗THSD7A抗体的存在情况。观察49例IMN患者接受免疫抑制治疗的进展情况，其中抗PLA2R(+)27例，抗THSD7A(+)6例，抗PLA2R(-)和抗THSD7A(-)双阴性16例。结果152例(71.7%)IMN患者和11例(9.3%)SMN患者抗PLA2R(+)、抗THSD7A(-)阳性。5例(2.4%)IMN患者和2例(1.7%)SMN患者抗THSD7A(+)、抗PLA2R(-)。其中1例IMN患者抗PLA2R(+)和抗THSD7A(+)。免疫抑制治疗后3个月(P=0.045)和6个月(P=0.006)，抗PLA2R(+)患者的部分缓解率低于抗PLA2R(-)患者。免疫抑制治疗12个月后，抗PLA2R(+)患者的完全缓解率低于抗PLA2R(-)患者(P=0.037)。结论血清抗PLA2R抗体水平可作为诊断IMN的敏感而特异的指标。免疫抑制治疗对抗PLA2R(-)的IMN患者比抗PLA2R(+)的IMN患者更有效。
BackgroundM-type phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing 7A (THSD7A) have recently been identified as target antigens for patients with idiopathic membranous nephropathy (IMN). The prevalence of PLA2R and THSD7A in the serum of MN patients deserves further investigation.MethodsHere, we studied the presence of anti-PLA2R and anti-THSD7A antibodies in patients with biopsy-proven IMN (n=212), secondary membranous nephropathy (SMN, n=118), and other kidney diseases (n=84). The progress of 49 IMN patients [anti-PLA2R(+), n=27; anti-THSD7A(+), n=6; anti-PLA2R(-) and anti-THSD7A(-) dual negative, n=16] who received immunosuppressive therapy was observed for 12months. Serum concentrations of antibodies against PLA2R and THSD7A were detected using an indirect immunofluorescent assay.ResultsOne hundred fifty-two (71.7%) IMN patients and 11 (9.3%) SMN patients were identified as anti-PLA2R(+) anti-THSD7A(-). Five (2.4%) IMN patients and two (1.7%) SMN patients were identified as anti-THSD7A(+) anti-PLA2R(-). One of the IMN patients was identified as anti-PLA2R(+) and anti-THSD7A(+). The rate of partial remission was lower in anti-PLA2R(+) patients than in anti-PLA2R(-) patients 3months (P=0.045) and 6months (P=0.006) after immunosuppressive therapy. The rate of complete remission was lower in anti-PLA2R(+) patients than in anti-PLA2R(-) patients 12months (P=0.037) after immunosuppressive therapy.ConclusionsThe serum concentration of anti-PLA2R antibodies may be used as a sensitive and specific marker for diagnosing IMN. Immunosuppressive therapy is more effective for IMN patients who are anti-PLA2R(-) than for those who are anti-PLA2R(+).