Detection And The Clinical Significance Of M Type Phospholipase A2 Receptor And Autoantibodies Against M Type Phospholipase A2 Receptor In Patients With Idiopathic Membranous Nephropathy

Objective: To explore the role of M type phospholipase A2 receptor in glomeruli and serum M type phospholipase A2 receptor antibody in diagnosis and evaluation of idiopathic membranous nephropathy.Methods:1 A total of 108 patients with biopsy-proved MN were collected in this study as experimental group,including 80 patients with idiopathic membranous nephropathy(IMN),45 males and 35 females,mean age(43.69 ± 12.79)years old;20 patients with HBV-MN,10 males and 10 females,mean age(45.5 ± 11.75)years old;8 cases with stage V lupus nephritis(LN-V),2 males and 6 females,mean age(35 ± 13.63)years old.21 patients with biopsy-proved minimal change nephropathy(MCD)were regarded as control group,15 males and 6 females,mean age(37.43 ± 19.99)years old.2 Records general information and clinical data of the patient,including age,height,weight,BMI,SP,DP,history,ALB,BUN,Scr,UA,CHOL,TG and 24-hour urine protein.3 PLA2 R in glomeruli were detected by immunohistochemical staining.Serum PLA2 R antibodies(PLA2R-Abs)were measured by enzyme linked immunosorbent assay,regarded <14RU / ml as a negative result and ≥20RU / ml as a positive result.According to serum PLA2R-Abs levels,IMN patients were divided into positive and negative groups.Afterward,the correlation between serum PLA2R-Abs and PLA2 R in glomeruli and clinical data was analyzed.4 Application SPSS20.0 software for statistical analysis,take α=0.05 as a test level,P<0.05 represents the difference was statistically significant.Results: 1 PLA2 R can be seen staining along the glomerular capillary loops.Positive PLA2 R glomerular deposits were found in 72.5% IMN patients,while it was only 25%,0% and 0% in patients with HBV-MN,LN-V and MCD,Compared with the IMN group,PLA2 R expression quantity was significantly lower in the rest of the three groups,P <0.05.Compared with the HBV-MN group,PLA2 R expression quantity was significantly lower in the MCD group,P <0.05.No significant differences were found in PLA2 R expression quantity between HBV-MN and LN-V,LN-V and MCD groups;2 Positive PLA2R-Abs were detect in 83.8% IMN patients,while it was only 15%,12.5% and 0% in patients with HBV-MN,LN-V and MCD,Compared with the IMN group,PLA2 R expression quantity was significantly lower in the rest of the three groups,P <0.05.No significant differences were found in HBV-MN,LN-V and MCD groups.Concentration of PLA2R-Abs was 81.29(91.3)RU/ml,6.25(13.2)RU/ml,6.93(11.3)RU/ml and 3.08(4.7)RU/ml in IMN,HBV-MN,LN-V and MCD groups;3 Concentration of serum albumin was(23.85±4.99)g/L in PLA2R-Abs positive group,lower than that in the PLA2R-Abs negative group(32.76±6.38)g/L,Concentration of proteinuria was(5.02±2.16)g/d in PLA2R-Abs positive group,higher than that in the PLA2R-Abs negative group(3.14±2.68)g/d,the difference was statistically significant(P<0.05);4 Spearman rank correlation analysis showed that serum PLA2R-Abs levels were positively correlated with proteinuria and serum cholesterol levels,and negatively correlated with serum albumin levels.Conclusions:1 This experiment shows that the PLA2 R and PLA2R-Abs both can be regarded as a specific marker for the diagnosis of IMN,detection of serum PLA2R-Abs positive rate higher than PLA2 R in glomeruli.2 Serum PLA2R-Abs is an important indicator to reflect the severity of IMN in patients.