| Objective: To investigate the relationship between the expression of the M phospholipase A2 receptor(PLA2R)in renal tissue and the prognosis of Atypical membranous nephropathy(AMN)patients.Methods:The patients who were diagnosed as Primary membranous nephropathy(PMN)and Atypical membranous nephropathy(AMN)by renal biopsy at the First Hospital Affiliated Hospital of Dalian Medical University from January 2008 to December 2017 were enrolled in the patients with nephrotic syndrome.The R language was used to screen patients at a ratio of 1:2 to eliminate differences between groups.In the law of sufficient glucocorticoid treatment after 8 weeks,combined with the using of tacrolimus(FK506)/ cyclophosphamide(CTX)/mycophenolate mofetil(MMF).The urine protein count,serum albumin,blood lipid,serum creatinine,immunoglobulin IgG,IgA,IgM,C3 and C4 were recorded in the early and follow-up of all the patients.All patients were followed up once a month,and patients who arrived CR were followed up for 3 months.The follow-up period was set at 36 months.The differences in expression of PLA2 R in AMN and PMN kidney tissues were detected by triple immunofluorescence staining.Results:35 cases of AMN,70 cases of PMN,the incidence rate of the two groups was 1.19:1(male 19,female 16)VS 1.69:1(male 44,female 26)(P=0.398),The average age of renal biopsy was 54.3±14.9 VS 50.0±13.9 岁(P=0.144),In both groups,the incidence of male morbidity was higher than that of women,but there was no statistical difference between the two groups.The average age of onset of AMN group was greater than that of PMN group,but there was no statistical difference between the two groups.In addition,there were no statistically significant differences in serum albumin,urine protein quantitation,average blood pressure,serum creatinine,immunoglobulin,complement and Clinical medication regimen.However,12 cases(34.29%)of AMN had the pathological changes of spikes,while 50 cases(71.43%)of PMN had the pathological changes of spikes,There was a significant difference between the two groups,suggesting there may be differences in pathological structure.Thirty-five patients from AMN and seventy patients from PMN,The median follow-up was 32 months [interquartile range,16;36] VS 36 months [interquartile range,15;36](P=0.730).Kaplan-meier curve was used to analyze the cumulative remission rate of patients in both groups.The results of log-rank test showed that the cumulative remission rate of AMN and PMN patients were no difference(P = 0.102)during the 36 months of follow-up,and the cumulative remission rate of PMN group was higher,and the time was shorter.Morever,the cumulative remission rate of PMN group in the 12 th was higher than that in the AMN group(P = 0.025),while the cumulative remission rate in the 24 th and the 36 th months was no difference(P>0 0.05).16 of 35 AMN were relieved,including 6 completely remission and 10 partially remission.19 cases(54.3%)were not alleviated,one of them progressed to ESRD and finally entered hemodialysis,two patients were found lung cancer during follow-up,and one patient were found the sicca syndrome.In the PMN group,47 patients(67.1%)were relieved: 19 cases were completely relieved,and 28 were partially relieved.And 23 cases(32.9%)did not alleviate.The PLA2 R expression in kidney tissue: the positive rate of PLA2 R in AMN was 34.3% while in PMN was 71.4%,There was a significant difference between two groups.Further with the PLA2 R positive/negative group:There were no statistically significant differences in age,blood pressure,urine protein quantitation,serum albumin,serum lipids,immunoglobulin and complement in the four groups(P > 0.05).Further application of multivariate COX regression analysis: renal PLA2 R antigen was associated with poor prognosis in AMN patients(HR=0.581,95%CI:0.348-0.970,P=0.038).Conclusion: The positive rate of PLA2 R in the AMN group was lower than that of PMN,and the renal PLA2 R was associated with the prognosis of AMN. |
PDF Full Text Request