Clinical Significance Study Of Serum Anti-phospholipase A2 Receptor Antibody In The Diagnosis And Treatment Of Primary Membranous Nephropathy

Objective: To analyze the relationship between the level of anti-phospholipase A2 receptor(PLA2R)antibody and primary membranous nephropathy(PMN)and its correlation with clinical indicators.To explore a more suitable cut-off value for Chinese patients.Methods: One hundred and seventy-six patients with PMN proven by renal biopsy at hebei general hospital from March 2017 to December 2018 were enrolled in this study,39 patients with no-PMN kidney diseases were selected,and 30 healthy people who had physical examination in our hospital at the same period were selected as control group.Serum titer of anti-PLA2 R antibody in each group was measured by enzyme-linked immunosorbent assay(ELISA).The influential factors of PMN were identified by Logistic regression analysis,and the optimal cut-off value of PMN was analyzed by ROC curve.Results: The sensitivity and specificity of serum anti-PLA2 R antibody in PMN were 77.9%and 100%.The antibody level in PMN group was significantly higher than that in no-PMN nephropathy group and control group(P< 0.05),the 24 h urinary protein,urea nitrogen,total cholesterol and triglyceride in PMN group were significantly higher than those in no-PMN nephropathy group and control group,and the plasma total protein and albumin in PMN group were significantly lower than those in no-PMN nephropathy group and control group(P< 0.05),the proportion of nephrotic category proteinuria in PMN and non-PMN nephropathy groups was significantly higher than that in control group(P< 0.05).The 24 h urine protein and total cholesterol in serum anti-PLA2 R antibody positive group was significantly higher than those in the antibody negative group,while plasma total protein and albumin in the antibody positive group were significantly lower than those in the antibody negative group,and the difference between the two groups was statistically significant(P< 0.05),the proportion of nephrotic category proteinuria in antibody positive group was significantly higher than that in antibody negative group,and the difference between the two groups was statistically significant(P< 0.05).Serum anti-PLA2 R antibody titer in antibody positive group was positively correlated with 24 h urinary protein quantification(r= 0.338,P<0.001),serum creatinine(r= 0.289,P= 0.001),urea nitrogen(r= 0.210,P=0.014),and was negatively correlated with plasma total protein(r= 0.210,P=0.014),plasma albumin(r= 0.266,P= 0.002),estimate glomerular filtration rate(r= 0.369,P< 0.001).When the cut-off value of anti-PLA2 R antibody for the diagnosis of PMN was 11.35 RU/ml,the sensitivity and specificity of distinguishing PMN from other pathological types were 80.7% and 100%,respectively.Conclusions: The level of anti-PLA2 R antibody in adult PMN patients is significantly higher than that in other pathological types and secondary membranous nephropathy patients,indicating high sensitivity and specificity for the diagnosis of PMN.In addition,there is a certain correlation between anti-PLA2 R antibody and PMN,which can effectively reflect disease activity of PMN.The cut-off value of anti-PLA2 R antibody is 11.35RU/ml,indicating reliable diagnostic value.