尿液中磷脂酶A2受体的浓度与特发性膜性肾病患者临床及预后的相关性

    Correlation between urinary concentration of phospholipase A2 receptor and clinical characteristics and prognosis of idiopathic membranous nephropathy patients

    • 摘要: 目的探讨尿液中磷脂酶A2受体(phospholipase A2 receptor,PLA2R)的浓度与特发性膜性肾病(idiopathic membranous nephropathy,IMN)临床严重程度的相关性,分析其在IMN病情评估及预后判断中的价值。方法选取2017年12月至2018年12月广东省人民医院肾内科经肾活检证实的38例IMN患者,利用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测患者尿PLA2R浓度,采用偏相关方法分析尿PLA2R浓度与患者基线临床数据的相关性,通过受试者工作特征曲线和Logistic回归评估尿PLA2R浓度对患者6个月蛋白尿完全缓解的预测价值。结果 ELISA法测得的尿PLA2R浓度中位数是0.061 μg/L,偏相关分析示尿PLA2R浓度与IMN患者基线估算肾小球滤过率(rs=-0.507,P=0.002)及血清白蛋白(rs=-0.464,P=0.004)呈负相关,与基线24 h尿蛋白定量呈正相关(rs=0.700,P<0.001)。随访6个月,发现蛋白尿完全缓解组患者尿PLA2R浓度明显低于非完全缓解组0.024(0.012,0.057)μg/L比0.102(0.041,0.326)μg/L,P=0.008。多因素Logistic回归分析示尿液中PLA2R浓度水平是IMN患者6个月蛋白尿完全缓解的独立预测因素OR=0.053(0.003~0.865),P=0.039。结论尿PLA2R浓度与IMN患者的病情严重程度呈正相关,且可独立预测IMN患者6个月蛋白尿完全缓解情况。

       

      Abstract: Objective To explore the relationship of urinary concentration of phospholipase A2receptor(PLA2R)with clinical severity of idiopathic membranous nephropathy(IMN)patients and analyze its value in IMN disease assessment and prognosis.Methods From December 2017 to December2018,a retrospective reviewed for 38 IMN patients confirmed by kidney biopsy. Urinary concentration of PLA2R was detected by enzyme-linked immunosorbent assay(ELISA)and partial correlation method employed for examining the correlation between urinary PLA2R concentration and clinical data. The predictive value of urinary PLA2R concentration for complete remission of proteinuria within 6 months was evaluated by receiver operating characteristic curve and Logistic regression analysis.Results Partial correlation analysis indicated that urinary concentration of PLA2R——a median of 0.061 μg/L——was negatively correlated with baseline estimated glomerular filtration rate(eGFR)(rs=-0.507,P=0.002)and serum albumin(rs=-0.464,P=0.004);positively correlated with 24h total urinary protein(rs=0.700,P<0.001).During 6-month follow-ups,urinary PLA2R concentration was significantly lower proteinuria in complete remission group than that in non-complete remission group0.024(0.012,0.057)μg/L vs 0.102(0.041,0.326)μg/L,P=0.008. Multivariate Logistic regression analysis showed that urinary concentration of PLA2R was an independent predictor of complete remission of proteinuria within 6 monthsOR=0.053(0.003-0.865),P=0.039.Conclusion Positively correlated with the severity of IMN patients,urinary PLA2R concentration may independently predict a complete remission of proteinuria within 6 months.

       

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