The Correlation Between Features,Response To Therapy And Anti M-type Phospholipase A2 Receptor Antibody Of Idiopathic Membranous Nephropathy

Objective: Through analyzing the relationship between laboratory parameters,clinical manifestation, glomerular immunofluorescence, pathological stage,response to therapy and M-type phospholipase A2 receptor(PLA2R) antibody of patients with idiopathic membranous nephropathy(IMN), preliminary study the significance of M-type phospholipase A2 receptor antibody on IMN diagnosising,clinical manifestation, judge of pathological changes and response to therapy.Methods: Fifty-six patients who were diagnosed with IMN by renal biopsy were collected from China-Japan union hospital of Jilin university since September 2013 to August 2015, Enzyme-linked immunoabsorbent assay(ELISA) methods were applied to detect the serum anti- PLA2 R antibody of these patients,then devide these patients into antibody-positive group and antibody-negative group according to serum antibody detection results, collect and record baseline data of the two groups of patients, using statistical software to analyze the differences of baseline laboratory parameters and the number of patients with nephrotic syndrome between the two groups; Light and electron microscopy renal pathologic test and immunofluorescence test was given to the two group of IMN patients, record the number of patients with stage I,I~II,II,II or more and the number of patients with IgG1 subtype deposition, IgG4 subtype deposition and PLA2 R expression in renal immunofluorescence test, statistical software was used to analysis the differences in the number of cases of patients with different types between the two groups.The same proportions of general treatment,treatment with hormone, hormone combined with cyclophosphamide and hormone combined with tacrolimus was given to the two groups of patients,following up for 6 months,record the laboratory parameters and the number of patients with complete remission, partial remission and no remission after treatment.Statistical software was used to analyze the differences in laboratory parameters and response to treatment between the two groups.Results:(1)There are 40 cases of patients with serum anti-PLA2 R antibody positive and 16 cases of patients with serum anti-PLA2 R antibody negative in all 56 cases of patients with IMN, no statistical difference was found in average age, course of disease,sex ratio between the two groups.The serum albumin levels of anti-PLA2 R antibody positive group is lower than anti-PLA2 R antibody negative group, the 24-hour urine protein level of anti-PLA2 R antibody positive group is higher than anti-PLA2 R antibody negative group, the differences were statistically significant(P<0.05), other differences in laboratory parameters were not statistically significant(P≥0.05);(2)The number of patients who manifested as nephrotic syndrome is 35 in anti-PLA2 R antibody positive group,while the number of patients who manifested as nephrotic syndrome is 10 in anti-PLA2 R antibody negative group, the proportion of patients who manifested as nephrotic syndrome is higher in anti-PLA2 R antibody positive group than in anti-PLA2 R antibody negative group,the differences were statistically significant(P<0.05);(3)The differences in the proportion of every renal pathological stage of the two groups were not statistically significant(P≥0.05),but the proportion of patients with IgG1 subtype deposition in anti-PLA2 R antibody positive group is lower than in anti-PLA2 R antibody negative group, the proportion of patients with IgG4 subtype deposition in anti-PLA2 R antibody positive group is higher than in anti-PLA2 R antibody negative group,the differences were statistically significant(P<0.05),the differences of PLA2 R expression between the two groups were statistically significant(P<0.05);(4)The differences in laboratory parameters and the rate of complete remission, partial remission,no remission after treatment between anti-PLA2 R antibody positive group and anti-PlA2 R antibody negative group were not statistically significant(P≥0.05).Conclusions:(1)The positive rate of serum anti-PLA2 R antibody in patients with IMN is relatively high,which is helpful to the diagnosis of the disease;(2)The serum anti-PLA2 R antibody positive patients with IMN is more easily to be manifested as nephrotic syndrome,we can predict the clinical manifestations of IMN patients and guide the clinical medication according to serum anti-PLA2 R antibody test results;(3)The serum anti-PLA2 R antibody is positive or not have no correlation with the renal pathological stage of IMN patient,but the renal tissue of IMN patients with serum anti-PLA2 R antibody positive are more likely to be manifested as IgG4 subtype strong positive deposition and expression of PLA2R;(4)The serum anti-PLA2 R antibody is positive or not have no correlation with response to therapy in patients with IMN who manifested as nephrotic syndrome,therefore,we can’t predict the response to therapy of IMN patient by detecting serum anti-PLA2 R antibody.