中华检验医学杂志
中華檢驗醫學雜誌
중화검험의학잡지
Chinese Journal of Laboratory Medicine
2015年
9期
595-599
,共5页
受体,磷脂酶A2%肾小球肾炎,膜性%自身抗体%荧光抗体技术,间接
受體,燐脂酶A2%腎小毬腎炎,膜性%自身抗體%熒光抗體技術,間接
수체,린지매A2%신소구신염,막성%자신항체%형광항체기술,간접
Glomerulonephritis,membranous%Receptors,phospholipase A2%Autoantibodies%Fluorescent antibody technique,indirect
目的:探讨抗磷脂酶A2受体(PLA2R)抗体在成人特发性膜性肾病(IMN)中的诊断作用和联合监测价值。方法回顾性研究,选择2013年1月至2014年6月期间辽宁中医药大学附属医院、中国医科大学附属盛京医院肾内科住院患者肾活检明确诊断的IMN患者48例,非特发性膜性肾病( NIMN)患者115例(其中过敏性紫癜性肾病亚组23例,狼疮性肾病亚组39例,IgA肾病亚组24例,肿瘤相关肾病亚组29例);选择辽宁中医药大学附属医院临床体检中心体检健康的志愿者35例作为对照组。采用间接免疫荧光法(IIF)检测各组患者血清中PLA2R抗体,并观察抗体荧光强度与IMN组病理分期及24小时尿蛋白(24 h PRO)、血尿素氮(UREA)、胱抑素C(CYSC)、血尿酸(URIC)、肾小球滤过率估算值( eGFR)等进行相关性分析。组间比较采用t检验,χ2做相关性分析。结果(1)48例IMN组血清标记的基质片中,37例标本PLA2R抗体基质荧光呈阳性,阳性率为77.08%;NIMN组中,基质胞浆荧光均为阴性。 IMN组患者血清PLA2R抗体的敏感度为77.08%,其特异度达100.00%。(2)与对照组比较,IMN组各肾功能主要相关指标均明显增高,差异有统计学意义(对照组与IMN组UREA分别为4.12±1.25、6.02±2.28, t=4.446,P=0.00;UA分别为262±49、331±112, t=2.577,P=0.017;CYSC分别为0.78±0.21、1.16±0.27, t=4.63,P=0.00);NIMN组各亚组肾功能主要相关指标也存在差异有统计学意义(对照组与过敏性紫癜性肾病亚组UREA分别为4.12±1.25、5.43±1.84,t=3.606,P=0.0002;UA分别为262±49、299±51, t=1.050,P=0.03;CYSC分别为0.78±0.21、1.06±0.31, t=1.672,P=0.02。对照组与狼疮性肾病亚组UREA分别为4.12±1.25、5.90±2.20,t=4.225,P=0.00;UA分别为262±49、342±92,t=2.409,P=0.026;CYSC分别为0.78±0.21、0.92±0.24, t=1.674,P=0.00。对照组与IgA肾病亚组UREA分别为4.12±1.25、6.69±2.87,t=4.756,P=0.00;UA分别为262±49、361±52, t=4.598,P=0.00;CYSC分别为0.78±0.21、1.30±0.36, t=4.752,P=0.00。对照组与肿瘤相关肾病亚组UREA分别为4.12±1.25、5.02±1.70,t=3.626,P=0.002;UA分别为262±49、289±92, t=0.05,P=0.01;CYSC分别为0.78±0.21、0.98±0.20, t=1.1,P=0.01)。 IMN组与NIMN组中的4个亚组肾功能相关指标比较差异无统计学意义(P>0.05)。(3) IMN组的PLA2R抗体荧光强度与24 h PRO呈正相关(r=0.877, P=0.00),与URIC呈正相关(r=0.766,P=0.00)。(4)IMN组血清中抗PLA2R抗体水平与病理Ⅰ期、Ⅱ期、Ⅲ期分期无相关性( r值分别为0.087、0.194、0.182;P值分别为0.598、0.399、0.667),但抗体阳性率(Ⅰ期37.50%、Ⅱ期84.85%、Ⅲ期85.71%)可随着病情严重程度有递增趋势。结论PLA2R抗体可能是新的IMN的实验室诊断指标。(中华检验医学杂志,2015,38:595-599)
目的:探討抗燐脂酶A2受體(PLA2R)抗體在成人特髮性膜性腎病(IMN)中的診斷作用和聯閤鑑測價值。方法迴顧性研究,選擇2013年1月至2014年6月期間遼寧中醫藥大學附屬醫院、中國醫科大學附屬盛京醫院腎內科住院患者腎活檢明確診斷的IMN患者48例,非特髮性膜性腎病( NIMN)患者115例(其中過敏性紫癜性腎病亞組23例,狼瘡性腎病亞組39例,IgA腎病亞組24例,腫瘤相關腎病亞組29例);選擇遼寧中醫藥大學附屬醫院臨床體檢中心體檢健康的誌願者35例作為對照組。採用間接免疫熒光法(IIF)檢測各組患者血清中PLA2R抗體,併觀察抗體熒光彊度與IMN組病理分期及24小時尿蛋白(24 h PRO)、血尿素氮(UREA)、胱抑素C(CYSC)、血尿痠(URIC)、腎小毬濾過率估算值( eGFR)等進行相關性分析。組間比較採用t檢驗,χ2做相關性分析。結果(1)48例IMN組血清標記的基質片中,37例標本PLA2R抗體基質熒光呈暘性,暘性率為77.08%;NIMN組中,基質胞漿熒光均為陰性。 IMN組患者血清PLA2R抗體的敏感度為77.08%,其特異度達100.00%。(2)與對照組比較,IMN組各腎功能主要相關指標均明顯增高,差異有統計學意義(對照組與IMN組UREA分彆為4.12±1.25、6.02±2.28, t=4.446,P=0.00;UA分彆為262±49、331±112, t=2.577,P=0.017;CYSC分彆為0.78±0.21、1.16±0.27, t=4.63,P=0.00);NIMN組各亞組腎功能主要相關指標也存在差異有統計學意義(對照組與過敏性紫癜性腎病亞組UREA分彆為4.12±1.25、5.43±1.84,t=3.606,P=0.0002;UA分彆為262±49、299±51, t=1.050,P=0.03;CYSC分彆為0.78±0.21、1.06±0.31, t=1.672,P=0.02。對照組與狼瘡性腎病亞組UREA分彆為4.12±1.25、5.90±2.20,t=4.225,P=0.00;UA分彆為262±49、342±92,t=2.409,P=0.026;CYSC分彆為0.78±0.21、0.92±0.24, t=1.674,P=0.00。對照組與IgA腎病亞組UREA分彆為4.12±1.25、6.69±2.87,t=4.756,P=0.00;UA分彆為262±49、361±52, t=4.598,P=0.00;CYSC分彆為0.78±0.21、1.30±0.36, t=4.752,P=0.00。對照組與腫瘤相關腎病亞組UREA分彆為4.12±1.25、5.02±1.70,t=3.626,P=0.002;UA分彆為262±49、289±92, t=0.05,P=0.01;CYSC分彆為0.78±0.21、0.98±0.20, t=1.1,P=0.01)。 IMN組與NIMN組中的4箇亞組腎功能相關指標比較差異無統計學意義(P>0.05)。(3) IMN組的PLA2R抗體熒光彊度與24 h PRO呈正相關(r=0.877, P=0.00),與URIC呈正相關(r=0.766,P=0.00)。(4)IMN組血清中抗PLA2R抗體水平與病理Ⅰ期、Ⅱ期、Ⅲ期分期無相關性( r值分彆為0.087、0.194、0.182;P值分彆為0.598、0.399、0.667),但抗體暘性率(Ⅰ期37.50%、Ⅱ期84.85%、Ⅲ期85.71%)可隨著病情嚴重程度有遞增趨勢。結論PLA2R抗體可能是新的IMN的實驗室診斷指標。(中華檢驗醫學雜誌,2015,38:595-599)
목적:탐토항린지매A2수체(PLA2R)항체재성인특발성막성신병(IMN)중적진단작용화연합감측개치。방법회고성연구,선택2013년1월지2014년6월기간료녕중의약대학부속의원、중국의과대학부속성경의원신내과주원환자신활검명학진단적IMN환자48례,비특발성막성신병( NIMN)환자115례(기중과민성자전성신병아조23례,랑창성신병아조39례,IgA신병아조24례,종류상관신병아조29례);선택료녕중의약대학부속의원림상체검중심체검건강적지원자35례작위대조조。채용간접면역형광법(IIF)검측각조환자혈청중PLA2R항체,병관찰항체형광강도여IMN조병리분기급24소시뇨단백(24 h PRO)、혈뇨소담(UREA)、광억소C(CYSC)、혈뇨산(URIC)、신소구려과솔고산치( eGFR)등진행상관성분석。조간비교채용t검험,χ2주상관성분석。결과(1)48례IMN조혈청표기적기질편중,37례표본PLA2R항체기질형광정양성,양성솔위77.08%;NIMN조중,기질포장형광균위음성。 IMN조환자혈청PLA2R항체적민감도위77.08%,기특이도체100.00%。(2)여대조조비교,IMN조각신공능주요상관지표균명현증고,차이유통계학의의(대조조여IMN조UREA분별위4.12±1.25、6.02±2.28, t=4.446,P=0.00;UA분별위262±49、331±112, t=2.577,P=0.017;CYSC분별위0.78±0.21、1.16±0.27, t=4.63,P=0.00);NIMN조각아조신공능주요상관지표야존재차이유통계학의의(대조조여과민성자전성신병아조UREA분별위4.12±1.25、5.43±1.84,t=3.606,P=0.0002;UA분별위262±49、299±51, t=1.050,P=0.03;CYSC분별위0.78±0.21、1.06±0.31, t=1.672,P=0.02。대조조여랑창성신병아조UREA분별위4.12±1.25、5.90±2.20,t=4.225,P=0.00;UA분별위262±49、342±92,t=2.409,P=0.026;CYSC분별위0.78±0.21、0.92±0.24, t=1.674,P=0.00。대조조여IgA신병아조UREA분별위4.12±1.25、6.69±2.87,t=4.756,P=0.00;UA분별위262±49、361±52, t=4.598,P=0.00;CYSC분별위0.78±0.21、1.30±0.36, t=4.752,P=0.00。대조조여종류상관신병아조UREA분별위4.12±1.25、5.02±1.70,t=3.626,P=0.002;UA분별위262±49、289±92, t=0.05,P=0.01;CYSC분별위0.78±0.21、0.98±0.20, t=1.1,P=0.01)。 IMN조여NIMN조중적4개아조신공능상관지표비교차이무통계학의의(P>0.05)。(3) IMN조적PLA2R항체형광강도여24 h PRO정정상관(r=0.877, P=0.00),여URIC정정상관(r=0.766,P=0.00)。(4)IMN조혈청중항PLA2R항체수평여병리Ⅰ기、Ⅱ기、Ⅲ기분기무상관성( r치분별위0.087、0.194、0.182;P치분별위0.598、0.399、0.667),단항체양성솔(Ⅰ기37.50%、Ⅱ기84.85%、Ⅲ기85.71%)가수착병정엄중정도유체증추세。결론PLA2R항체가능시신적IMN적실험실진단지표。(중화검험의학잡지,2015,38:595-599)
Objective To investigate the diagnostic value and monitoring application of anti-phospholipase A2 receptor antibodies ( PLA2R ) in patients with idiopathic membranous nephropathy ( IMN) .Methods A retrospective study was used .48 patients were diagnosed as idiopathic membranous nephropathy by puncturing kidney from January of 2013 to June of 2014 in the Hospital of Liaoning Traditional Chinese Medical University and Shengjing Hospital of China Medical University were included. 43 patients were diagnosed as non-idiopathic membranous nephropathy ( NIMN ).35 healthy volunteers were selected as control groups.Serum PLA2R were detected by indirect immunofluorescence.The intensity of antibodies fluorescence and the level of urine protein in 24 hours(24 h PRO) ,serum UREA ,serum CYSC, serum UA,GFR were compared in each groups.Measurement data was shown as mean ±standard deviation;Count data was shown as frequency or composition, t test andχ2 test were used as statistical method.Results (1) Among 48 cases with IMN,37 cases showed positive PLA2R (positive rate 77.08%).All of cases were negative in NIMN group.The sensitivity and the specificity of serum PLA2R were 77.08%and 100%.(2) Compared with control groups, the levels of UREA, CYSC and UA were found statistically significant differences in patients with IMN ( P <0.05 ) .( The levels of UREA in control groups and IMN groups respectively:4.12 ±1.25,6.02 ±2.28, t =4.446,P=0.00;UA:262 ±49,331 ±112,t =2.577,P =0.017;CYSC:0.78 ±0.21,1.16 ±0.27,t=4.63,P=0.00.) Compared with control groups, the levels of main items in patients with NIMN had statistically significant differences (P<0.05).(The levels of UREA in control groups and Allergic purpura nephropathy subgroups respectively:4.12 ±1.25,5.43 ±1.84,t=3.606,P=0.000 2;UA:262 ±49, 299 ±51, t=1.050,P=0.03;CYSC:0.78 ±0.21, 1.06 ±0.31, t=1.672,P=0.02.The levels of UREA in control groups and lupus nephropathy subgroups respectively:4.12 ±1.25, 5.90 ±2.20,t=4.225,P=0.00;UA:262 ±49, 342 ±92,t=2.409,P=0.026;CYSC:0.78 ± 0.21,0.92 ±0.24, t =1.674, P =0.00.The levels of UREA in control groups and IgA nephropathy subgroups respectively:4.12 ±1.25,6.69 ±2.87,t=4.756,P=0.00;UA:262 ±49,361 ±52,t=4.598, P=0.00;CYSC:0.78 ±0.21, 1.30 ±0.36,t=4.752,P=0.00.The levels of UREA in control groups and tumor associated nephropathy subgroups respectively: 4.12 ±1.25, 5.02 ±1.70, t =3.626, P =0.002;UA:262 ±49, 289 ±92,t=0.05,P=0.01;CYSC:0.78 ±0.21, 0.98 ±0.20,t=1.1,P=0.01.) There was no statistically significant differences between IMN group and NIMN ( P >0.05 ) . ( 3 ) Positive correlation were found between 24 h PRO(r=0.877,P=0.00),serum UA (r=0.766,P=0.00 ) with the level of PLA2R antibodies fluorescence intensity.( 4 ) There were no correlation between serum PLA2R antibody with IMN pathology aging (r=0.087,0.194,0.182;P=0.598,0.399,0.667).PLA2R positive rate(Ⅰstage:37.50%,Ⅱstage:84.85%, Ⅲstage 85.71%) may increases with the increasing of illness severity.Conclusion Serum PLA2R antibody would be a new laboratory diagnosis standard in patients with IMN.(Chin J Lab Med, 2015, 38:595-599 ) Objective To investigate the diagnostic value and monitoring application of anti-phospholipase A2 receptor antibodies ( PLA2R ) in patients with idiopathic membranous nephropathy ( IMN) .Methods A retrospective study was used .48 patients were diagnosed as idiopathic membranous nephropathy by puncturing kidney from January of 2013 to June of 2014 in the Hospital of Liaoning Traditional Chinese Medical University and Shengjing Hospital of China Medical University were included. 43 patients were diagnosed as non-idiopathic membranous nephropathy ( NIMN ).35 healthy volunteers were selected as control groups.Serum PLA2R were detected by indirect immunofluorescence.The intensity of antibodies fluorescence and the level of urine protein in 24 hours(24 h PRO) ,serum UREA ,serum CYSC, serum UA,GFR were compared in each groups.Measurement data was shown as mean ±standard deviation;Count data was shown as frequency or composition, t test andχ2 test were used as statistical method.Results (1) Among 48 cases with IMN,37 cases showed positive PLA2R (positive rate 77.08%).All of cases were negative in NIMN group.The sensitivity and the specificity of serum PLA2R were 77.08%and 100%.(2) Compared with control groups, the levels of UREA, CYSC and UA were found statistically significant differences in patients with IMN ( P <0.05 ) .( The levels of UREA in control groups and IMN groups respectively:4.12 ±1.25,6.02 ±2.28, t =4.446,P=0.00;UA:262 ±49,331 ±112,t =2.577,P =0.017;CYSC:0.78 ±0.21,1.16 ±0.27,t=4.63,P=0.00.) Compared with control groups, the levels of main items in patients with NIMN had statistically significant differences (P<0.05).(The levels of UREA in control groups and Allergic purpura nephropathy subgroups respectively:4.12 ±1.25,5.43 ±1.84,t=3.606,P=0.000 2;UA:262 ±49, 299 ±51, t=1.050,P=0.03;CYSC:0.78 ±0.21, 1.06 ±0.31, t=1.672,P=0.02.The levels of UREA in control groups and lupus nephropathy subgroups respectively:4.12 ±1.25, 5.90 ±2.20,t=4.225,P=0.00;UA:262 ±49, 342 ±92,t=2.409,P=0.026;CYSC:0.78 ± 0.21,0.92 ±0.24, t =1.674, P =0.00.The levels of UREA in control groups and IgA nephropathy subgroups respectively:4.12 ±1.25,6.69 ±2.87,t=4.756,P=0.00;UA:262 ±49,361 ±52,t=4.598, P=0.00;CYSC:0.78 ±0.21, 1.30 ±0.36,t=4.752,P=0.00.The levels of UREA in control groups and tumor associated nephropathy subgroups respectively: 4.12 ±1.25, 5.02 ±1.70, t =3.626, P =0.002;UA:262 ±49, 289 ±92,t=0.05,P=0.01;CYSC:0.78 ±0.21, 0.98 ±0.20,t=1.1,P=0.01.) There was no statistically significant differences between IMN group and NIMN ( P >0.05 ) . ( 3 ) Positive correlation were found between 24 h PRO(r=0.877,P=0.00),serum UA (r=0.766,P=0.00 ) with the level of PLA2R antibodies fluorescence intensity.( 4 ) There were no correlation between serum PLA2R antibody with IMN pathology aging (r=0.087,0.194,0.182;P=0.598,0.399,0.667).PLA2R positive rate(Ⅰstage:37.50%,Ⅱstage:84.85%, Ⅲstage 85.71%) may increases with the increasing of illness severity.Conclusion Serum PLA2R antibody would be a new laboratory diagnosis standard in patients with IMN.