| Objective:To study the expression of anti-M-type phospholipase A2 receptor antibody(PLA2R-Ab)in different chronic kidney diseases and its significance in idiopathic membranous nephropathy(IMN),and to analyze the first symptoms of patients with chronic kidney disease(CKD),and to compare the Sensitivity and specificity of different thresholds(14RU/ml and 20RU/ml)in ELISA for the diagnosis of IMN.Methods:A retrospective analysis was made of the clinical and pathological data and the concentration of anti-PLA2 R antibody(detected by ELISA)in 109 patients with chronic kidney disease who were hospitalized for the first time in our hospital from March 2017 to February 2018.Idiopathic membranous nephropathy(SMN),secondary membranous nephropathy(SMN)and atypical membranous nephropathy(ATypical membranous nephropathy)were collected.Embranous nephropathy(AMN)patients were divided into positive group and negative group,and IMN patients were divided into negative group,low concentration group,medium concentration group and high concentration group.The patients in each group were analyzed and compared,and the relationship between anti-PLA2 R antibody and clinical indicators was explored.SPSS22.0 software was used for statistical analysis.P<0.05 was considered statistically significant.Results:1.1090 patients with CKD(610 males and 480 females,male to female ratio 1.27:1,average age 46.28+14.51),including idiopathic membranous nephropathy(IMN),secondary membranous nephropathy(SMN)[hepatitis B virus-associated glomerulonephritis(HBV-MN),type V lupus nephritis(LN-MN)],atypical membranous nephropathy and other non-MN nephropathy(IgA nephropathy,glomerular microlesions,hypertensive nephropathy,hypertensive nephropathy).Diabetic nephropathy,focal sclerosing glomerulonephritis,mild glomerular lesions,focal segmental glomerulosclerosis,IgM nephropathy,purpura nephritis,mesangial proliferative glomerulonephritis,membrano proliferative glomerulonephritis,lupus nephritis,renal amyloidosis,glomerulonephritis damage,obesity-related glomerulopathy except LN-MN.2.The first symptom was edema,accounting for 75.32%,of which 71.38% of the lower extremities were edema,2.29% of the binocular lid edema,1.65% of the facial edema,and 23.21% of the abnormal urine,accounting for 9.08% of the proteinuria,8.81% of the abnormal urine test,4.31% of the urine foam,0.28% of the abnormal urine color,and 0.73% of the intermittent gross hematuria.73%,low back pain 0.09%,general fatigue 0.09%,fever 0.09%.Edema or abnormal urine accounted for 98.53%,and the rest were atypical symptoms,accounting for 1.47%.3.IMN accounted for 56.24%,SMN accounted for 9.17%(HBV-MN accounted for 8.90%,LN-MN accounted for 0.28%),atypical MN accounted for 10%,other non-MN nephropathy accounted for 24.59%(IgA nephropathy accounted for 8.35%).Glomerular microlesions accounted for 5.14%.Hypertensive renal damage accounted for 1.10%.Diabetic nephropathy accounted for 1.65%.Focal sclerosing glomerulonephritis accounted for 0.46%.Mild glomerular lesions accounted for 1.65%.Focal segmental glomerulosclerosis accounted for 1.10%.IgM nephropathy accounted for 1.19%.Purpura kidney accounted for 1.19%.Mesenchymal proliferative glomerulonephritis accounted for 0.18%.Membranous proliferative glomerulonephritis type I accounted for 0.36%,lupus nephritis except LN-MN accounted for 1.01%.Renal amyloidosis accounted for 0.18%.The renal damage of vasculitis accounted for 0.55%.Obesity-related glomerulopathy accounted for 0.46%.In IMN patients,stage I MN accounted for 90.86%,stage II MN 7.01%,stage III MN 1.14%,stage IV MN 0.98%.4.The positive rate of anti-PLA2 R antibody,SMN,AMN and other non-MN nephropathy was 75.04%,77.00%(HBV-MN,77.32%,LN-MN,66.67%,63.30% and 0.75%,respectively)when the threshold of diagnosing IMN was(>14RU/ml).The positive rate of anti-PLA2 R antibody and SMN in IMN was 69.82%,67.00%(HBV-MN 68.04%,LN-MN 33.33%),56.88% in atypical MN and 0.37% in other non-MN nephropathy.5.The concentration of anti-PLA2 R antibody in IMN group was 57.14(14.56-134.86)RU/ml.SMN group was 51.33(15.42-134.19)RU/ml,HBV-MN was 52.82(15.84-133.27)RU/ml,LN-MN was 19.1(1.66-565.1)RU/ml,AMN group was 34.99(4.79-116.59)RU/ml,other non-MN nephropathy group was 1.52(1.27-1.87)RU/ml.6.The concentration of antibody,24-hour urinary protein,serum cholesterol,serum low density lipoprotein and serum triglyceride in IMN positive group were higher than those in negative group(P<0.01).The serum creatinine in positive group was higher than that in negative group(P<0.05).The serum total protein and serum albumin in the positive group were lower than those in the negative group(P<0.01).There was no significant difference in serum uric acid and hemoglobin between positive group and negative group(P>0.05).7.The antibody concentration of HBV-MN positive group was higher than that of negative group,and the difference was significant(P<0.01).The 24-hour urinary protein content and serum creatinine in positive group were higher than those in negative group,and the difference was statistically significant(P<0.05).The total serum protein and serum albumin in positive group were lower than those in negative group,and the difference was statistically significant(P<0.05).There was no significant difference in serum uric acid,cholesterol,low density lipoprotein,triglyceride and hemoglobin between positive group and negative group(P>0.05).8.The concentration of antibody and 24-hour urinary protein in atypical MN positive group were higher than those in negative group,with significant difference(P<0.01).The total serum protein and serum albumin in positive group were lower than those in negative group(P<0.01).There was no significant difference in serum creatinine,uric acid,triglyceride and hemoglobin between positive group and negative group(P>0.05).Serum cholesterol and low density lipoprotein in positive group were higher than those in negative group(P<0.01).9.With the increase of anti-PLA2 R antibody concentration in IMN negative group,low concentration group,medium concentration group and high concentration group,urinary protein increased(P<0.01),serum albumin decreased(P<0.01),cholesterol increased(P<0.05),and low density lipoprotein increased(P<0.05).10.Anti-PLA2 R antibodies were positively correlated with 24-hour urinary protein quantification,serum creatinine,cholesterol,low density lipoprotein and triglyceride(r values were 0.398,0.165,0.223,0.220,0.186,P <0.01),negatively correlated with total serum protein and serum albumin(r values were-0.303,-0.360,P<0.01),but not with serum uric acid and hemoglobin(P>0.05).11.For the different thresholds of 14RU/ml and 20RU/ml,the sensitivity,specificity,positive predictive value,negative predictive value,negative predictive value,negative predictive value and accuracy of anti-PLA2 R antibody in diagnosing IMN were 75.04% and 69.82%,69.39% and 72.96% respectively,75.91% and 76.84%,68.39% and 65.29%,72.57% and 71.19%,respectively.The area under ROC curve of anti-PLA2 R antibody for diagnosing IMN was 0.759(95% CI was 0.729-0.789,P<0.001).When the concentration of anti-PLA2 R antibody was 8.46RU/ml,the Yoden index was 0.492,the corresponding sensitivity was 81.10%,and the specificity was 68.10%.Therefore,based on ELISA,it is more important to select smaller 14RU/ml as the threshold for the detection of PLA2 R antibody in the diagnosis of IMN.Conclusions:1.Serum anti-PLA2 R antibody is a sensitive and specific marker for the iagnosis of MN.It is of great value in the diagnosis and differential diagnosis of MN,but it is difficult to differentiate between IMN and SMN.2.Anti-PLA2 R antibody was positively correlated with 24-hour urinary protein,serum creatinine,cholesterol,low density lipoprotein and triglyceride,negatively correlated with serum total protein and serum albumin,but not with serum uric acid and hemoglobin.It can be used as an important index for evaluating the condition of IMN.3.Based on ELISA,the threshold of 14RU/ml for anti-PLA2 R antibody has more important value in the diagnosis of IMN. |
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