[1]阎　磊,范晓光,高素华,等.肾组织M-型磷脂酶A2受体抗原阳性的特发性膜性肾病患者临床特征分析[J].新乡医学院学报,2017,34(8):700-703.[doi:10.7683/xxyxyxb.2017.08.010]
　YAN Lei,FAN Xiao-guang,GAO Su-hua,et al.Clinical features of patients with kidney tissue M-type phospholipase A2 receptor antigen positive idiopathic membranous nephropathy[J].Journal of Xinxiang Medical University,2017,34(8):700-703.[doi:10.7683/xxyxyxb.2017.08.010]
点击复制

肾组织M-型磷脂酶A2受体抗原阳性的特发性膜性肾病患者临床特征分析
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
34
期数:
2017年8
页码:
700-703
栏目:
临床研究
出版日期:
2017-08-05

文章信息/Info

Title:
Clinical features of patients with kidney tissue M-type phospholipase A2 receptor antigen positive idiopathic membranous nephropathy
作者:
阎　磊; 范晓光; 高素华; 顾　玥; 朱　清; 邵凤民
（河南省人民医院　郑州大学人民医院肾内科，河南　郑州　450003）
Author(s):
YAN Lei; FAN Xiao-guang; GAO Su-hua; GU Yue; ZHU Qing; SHAO Feng-min
（Department of Nephrology，Henan Provincial People′s Hospital，the People′s Hospital of Zhengzhou University，Zhengzhou 450003，Henan Province，China）
关键词:
特发性膜性肾病; M-型磷脂酶A2受体; 蛋白尿; 肾病综合征; 临床特征
Keywords:
idiopathic membranous nephropathy; M-type phospholipase A2 receptor; proteinuria; nephrotic syndrome; clinical features
分类号:
R692
DOI:
10.7683/xxyxyxb.2017.08.010
文献标志码:
A
摘要:
目的　检测特发性膜性肾病（IMN）患者肾组织M-型磷脂酶A2受体（PLA2R）抗原阳性率，分析其临床特征。方法　回顾性分析2014年1月至2015年12月河南省人民医院肾内科肾活组织检查诊断为IMN患者87例，应用间接免疫荧光法检测肾组织PLA2R抗原，分析其阳性率。收集患者肾穿刺活检时的性别、年龄、血尿素氮、血肌酐、血清白蛋白、血脂、24 h尿蛋白定量等临床资料，分析IMN患者临床特征与病理的关系。结果　在IMN患者87例中，81例（93.1%）肾组织PLA2R抗原阳性。81例PLA2R阳性患者中，男46例（56.8%），女35例（43.2%），男性居多。所有患者均存在不同程度的蛋白尿，表现为肾病综合征者49例（60.5％），合并高血压者28例（34.6％）。男性与女性相比，表现为肾病综合征者更常见，尿蛋白定量更大（P<0.05）；肾组织PLA2R抗原阳性者与阴性者相比，两者在发病年龄、血红蛋白、血脂等因素上差异无统计学意义（P>0.05）。与<45岁组患者比较，≥45岁组患者低血清白蛋白、高胆固醇的临床表现更明显；随着24 h尿蛋白定量的增加，血清白蛋白下降，血红蛋白、血尿素氮、血肌酐、血总胆固醇水平升高（P<0.05）。结论　IMN患者肾组织中PLA2R抗原阳性率高，可作为IMN病理检测指标；肾组织PLA2R抗原阳性的IMN 患者表现为肾病综合征者较为常见；男性、高龄及大量蛋白尿者，临床表现重。
Abstract:
Objective　To detect the positive rate of M-type phospholipase A2 receptor（PLA2R） antigen in renal tissue of idiopathic membranous nephropathy （IMN） patients，and analyze its clinical features.Methods　The clinical features of 87 patients with IMN which was diagnosed by renal biopsy in the Department of Nephrology，Henan Provincial People′s Hospital from January 2014 to December 2015 were analysed retrospectively.The PLA2R antigen in kidney tissue was detected by indirect immunofluorescence method，and its positive rate was analysed.The clinical data （including sex，age，blood urea nitrogen，serum creatinine，serum albumin，blood fat，24-hour urinary protein etc.） of patients were collected.The relationship between clinical features and pathology was analyzed in IMN patients.Results　In 87 IMN patients，the PLA2R antigen in renal tissue was was positive in 81 patients （93.1%）.Among the 81 patients with positive PLA2R antigen，there were 46（56.8%） males and 35（43.2%）females，the number of male was more than female.All patients had varying degrees of proteinuria，49（60.5%） patients were nephrotic syndrome，28（34.6%） patients were hypertension.Compared with female，nephrotic syndrome is more common and urine protein excretion was greater in male （P<0.05）.There was no significant difference in the age，hemoglobin，blood fat between PLA2R antigen positive patients and negative patients （P>0.05）.Compared with age<45 years group，the clinical manifestation of hypoalbuminemia，hypercholesterolemia was more obvious in age≥45 years group.With the increasing of 24-hour urinary protein excretion，the level of serum albumin was decreased，and the levels of hemoglobin，blood urea nitrogen，serum creatinine，total cholesterol were increased （P<0.05）.Conclusion　The positive rate of renal tissue PLA2R antigen is high in IMN patients，PLA2R antigen can be used as indicators of the pathological examination of IMN patients.Nephrotic syndrome is the major clinical manifestations in IMN patients with positive PLA2R antigen in renal tissue.Male，the elderly patients and the patients with a large number of proteinuria have severe clinical manifestations.

参考文献/References:

［1］　HORVATIC I，GALESIC K.Membranous glomerulonephritis：recent advances in pathogenesis and treatment［J］.Lijec Vjesn，2012，134（11/12）：328-339.
［2］　BECK L J，SALANT D J.Membranous nephropathy：recent travels and new roads ahead［J］.Kidney Int，2010，77（9）：765-770.
［3］　PAN X，XU J，REN H，et al.Changing spectrum of biopsy-proven primary glomerular diseases over the past 15 years：a single-center study in China［J］.Contrib Nephrol，2013，181：22-30.
［4］　SEGAL P E，CHOI M J.Recent advances and prognosis in idiopathic membranous nephropathy［J］.Adv Chronic Kidney Dis，2012，19（2）：114-119.
［5］　GLASSOCK R J.Diagnosis and natural course of membranous nephropathy［J］.Semin Nephrol，2003，23（4）：324-332.
［6］　BECK L J，BONEGIO R G，LAMBEAU G，et al.M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy［J］.N Engl J Med，2009，361（1）：11-21.
［7］　QIN W，BECK L J，ZENG C，et al.Anti-phospholipase A2 receptor antibody in membranous nephropathy［J］.J Am Soc Nephrol，2011，22（6）：1137-1143.
［8］　周广宇，金玲，于晶，等.成人膜性肾病患者血清抗PLA2R抗体与病情的相关性［J］.中华肾脏病杂志，2012，28（2）：111-114.
［9］　杨晓青，黄岩杰，丁樱，等.PLA2R在儿童和成人特发性膜性肾病肾组织中的表达［J］.中华肾脏病杂志，2014，30（12）：939-940.
［10］　祝爽爽，周树录，周朝敏，等.成人特发性膜性肾病肾组织M型磷脂酶A2受体1抗原的检测［J］.南方医科大学学报，2015，35（4）：526-529.
［11］　HANASAKI K.Mammalian phospholipase A2：phospholipase A2 receptor［J］.Biol Pharm Bull，2004，27（8）：1165-1167.
［12］　HANASAKI K，ARITA H.Phospholipase A2 receptor：a regulator of biological functions of secretory phospholipase A2［J］.Prostaglandins Other Lipid Mediat，2002，68-69：71-82.
［13］　LI L S，LIU Z H.Epidemiologic data of renal diseases from a single unit in China：analysis based on 13 519 renal biopsies［J］.Kidney Int，2004，66（3）：920-923.
［14］　STANESCU H C，ARCOS-BURGOS M，MEDLAR A，et al.Risk HLA-DQA1 and PLA（2）R1 alleles in idiopathic membranous nephropathy［J］.N Engl J Med，2011，364（7）：616-626.
［15］　BECK L J，FERVENZA F C，BECK D M，et al.Rituximab-induced depletion of anti-PLA2R autoantibodies predicts response in membranous nephropathy［J］.J Am Soc Nephrol，2011，22（8）：1543-1550.
［16］　HOFSTRA J M，BECK L J，BECK D M，et al.Anti-phospholipase A（2） receptor antibodies correlate with clinical status in idiopathic membranous nephropathy［J］.Clin J Am Soc Nephrol，2011，6（6）：1286-1291.
［17］　DEBIEC H，RONCO P.PLA2R autoantibodies and PLA2R glomerular deposits in membranous nephropathy［J］.N Engl J Med，2011，364（7）：689-690.
［18］　徐宁馨.PLA2R相关特发性膜性肾病的临床特征和PLA2R及其抗体的临床诊疗价值［D］.上海：复旦大学，2014.
［19］　SVOBODOVA B，HONSOVA E，RONCO P，et al.Kidney biopsy is a sensitive tool for retrospective diagnosis of PLA2R-related membranous nephropathy［J］.Nephrol Dial Transplant，2013，28（7）：1839-1844.
［20］　LARSEN C P，MESSIAS N C，SILVA F G，et al.Determination of primary versus secondary membranous glomerulopathy utilizing phospholipase A2 receptor staining in renal biopsies［J］.Mod Pathol，2013，26（5）：709-715.
［21］　PONTICELLI C，PASSERINI P.Can prognostic factors assist therapeutic decisions in idiopathic membranous nephropathy［J］.J Nephrol，2010，23（2）：156-163.
［22］　ZENG C H，CHEN H M，WANG R S，et al.Etiology and clinical characteristics of membranous nephropathy in Chinese patients［J］.Am J Kidney Dis，2008，52（4）：691-698.
［23］　丁小强，刘春凤.特发性膜性肾病研究进展［J］.中国实用内科杂志，2011，31（2）：108-112.
［24］　YOKOYAMA H，SUGIYAMA H，SATO H，et al.Renal disease in the elderly and the very elderly Japanese：analysis of the Japan Renal Biopsy Registry （J-RBR）［J］.Clin Exp Nephrol，2012，16（6）：903-920.
［25］　刘春凤，刘红，方艺，等.413例成人特发性膜性肾病（IMN）临床及病理分析［J］.复旦学报（医学版），2013，40（5）：516-522.
［26］　HONKANEN E，TORNROTH T，GRONHAGEN-RISKA C.Natural history，clinical course and morphological evolution of membranous nephropathy［J］.Nephrol Dial Transplant，1992，7（Suppl 1）：35-41.
［27］　刘俊，陈香美.蛋白尿加速肾小管损伤的作用机制［J］.中华肾病研究电子杂志，2014，3（2）：99-103.DOI：10.3877/cma.j.issn.2095-3216.2014.02.008.
［28］　HOFSTRA J M，FERVENZA F C，WETZELS J F.Treatment of idiopathic membranous nephropathy［J］.Nat Rev Nephrol，2013，9（8）：443-458.
［29］　张连云，刘云，郭明好.豫北地区1 200例经皮肾穿刺活组织检查患者临床病理分析［J］.新乡医学院学报，2010，27（4）：391-394.

相似文献/References:

[1]姬　萌,马媛媛,郭醉爽,等.昆仙胶囊与他克莫司治疗特发性膜性肾病疗效比较[J].新乡医学院学报,2021,38(5):472.[doi:10.7683/xxyxyxb.2021.05.016]
　JI Meng,MA Yuanyuan,GUO Zuishuang,et al.Comparison of the effects of Kunxian capsule and tacrolimus in the treatment of idiopathic membranous nephropathy[J].Journal of Xinxiang Medical University,2021,38(8):472.[doi:10.7683/xxyxyxb.2021.05.016]
[2]朱佳佳,马东红,刘　云,等.特发性膜性肾病患者足突宽度与尿蛋白量和他克莫司治疗反应的关系[J].新乡医学院学报,2017,34(5):381.[doi:10.7683/xxyxyxb.2017.05.009]
　ZHU Jia-jia,MA Dong-hong,LIU Yun,et al.Relationship between the foot process width，urinary protein and the patient′s response to tacrolimus in patients with idiopathic membranous nephropathy[J].Journal of Xinxiang Medical University,2017,34(8):381.[doi:10.7683/xxyxyxb.2017.05.009]

更新日期/Last Update: 2017-08-05