The Expression And Significance Of M Phospholipase A2 Receptor And Thrombospondin Type-1 Domain-containing 7A In Adult Idiopathic Membranous Nephropathy

Objective: To detect the M-type phospholipase A2 receptor(PLA2R),thrombospondin type-1 domain-containing 7A(THSD7A)expression in renal tissue and the levels of their antibodies in adult idiopathic membranous nephropathy(IMN).To evaluate the value of the two markers in the diagnosis of IMN.Method: 116 patients with biopsy-proven MN at The second hospital of Hebei Medical University from December 2014 to August 2015 were collected,including 86 patients with idiopathic membranous nephropathy(IMN),10 patients with HBV-MN and 10 cases with stage V lupus nephritis(LN-V).20 patients with minimal change disease(MCD)were regarded as control group.We conducted immunohistochemical analysis of the presence of THSD7 A and PLA2R the Paraffin section and Enzyme-linked immuno-absorbentassay(ELISA)methods detecting serum PLA2R-AB and THSD7A-AB concentration to investigate whether there is a correlation between them and clinical Indicators.Results: 1 Expression of PLA2R was detected in 88.4%,47.4%,10% and 0%,respectively,of the patients with IMN,HBV-MN,LN-V and MCD.Compared with the Secondary membranous nephropathy(SMN)and MCD groups was significantly higher in IMN groups(P <0.05).the positive rate of THSD7 A was detected in 2.3% of the patients with IMN and not detected in SMN and MCD.2 The titer of PLA2R-AB was detected 80.5(41.7,148.5)、10.9(5.6,28.6)、12.1(5.6,25.1)、3.6(2.3,10.1)and the positive rate in 82.6%,15%,10%,0%,respectively,of the patients with IMN,HBV-MN,LN-V and MCD.THSD7A-AB was negative in all patients.Compared with the Secondary membranous nephropathy(SMN)and MCD groups,the titer and positive rate of PLA2R-AB was significantly higher in IMN groups(P<0.05).3 Compared with serum PLA2R-Ab negative individuals,patients with serum PLA2R-Ab positivehad lower serum albumin(23.8±5.0 VS 32.9±6.2g/l)(P <0.05),higher urine protein excretion(5.1±2.6 vs 3.2±2.7g/d)(P=0.01).4 The sensitivity of PLA2R-AB,PLA2 R,THSD7A and PLA2R + THSD7 A in the diagnosis of IMN were 82.6%,88.4%,2.3%,88.6%,and the specificity was 92%,66.7%,100%,66.7%,respectively.Conclusion: PLA2R and THSD7 A in renal tissue and serum PLA2R-AB are specific markers for the diagnosis of IMN,which are closely related with the severity of IMN.The combined detection of PLA2R in renal tissue and its serum antibody can improve the positive detection rate.Expression of THSD7 A was positive in some of IMN patients with negative PLA2R.