The Relationship Between Serum Anti-PLA2R Antibody And Renal PLA2R And The Diagnosis And Prognosis Of Idiopathic Membranous Nephropathy

Objective By analyzing the serum anti-PLA2 R antibody titers and renal PLA2 R in patients with idiopathic membranous nephropathy,combined with renal biopsy pathological results,we study the relationship between serum anti-PLA2 R antibody titers and renal pathological immunofluorescence and the relationship with renal PLA2 R deposition.To further study the significance of PLA2 R in IMN diagnosis,disease judgment and prognosis.Methods Patients who were diagnosed as IMN by renal biopsy in Shengjing Hospital from September 2016 to December 2018 were selected.We collect clinical data and pathological data of patients and follow up.The serum anti-PLA2 R antibody titers of all patients were determined by ELISA,and were divided into negative group and positive group according to antibody titers.In the positive group,they were further divided into two subgroups: high titer group and low titer group.We compare the differences in clinical data and pathological data between the groups,combined with kidney PLA2 R antigen expression and renal pathological immunofluorescence results,analyze the relationship between serum antiPLA2 R antibody and renal PLA2 R antigen and IMN diagnosis and prognosis Results A total of 222 patients diagnosed with IMN by renal biopsy at Shengjing Hospital from September 2016 to December 2018 were collected.The male to female ratio was 1.34: 1,and the average age was 50.27 ± 12.07 years.1、There was a statistically significant difference between the serum anti-PLA2 R antibody-positive group and the negative group in 24 h urine protein quantification、ALB、urine RBC/HP、WBC/HP、ALT and DD(P<0.05).The eGFR in the higher titer group was lower than that in the low titer group.2、The positive rate of C3 deposition in the kidney tissue of the serum anti-PLA2 R antibody positive group was higher than that in the negative group,the difference was statistically significant(P=0.001).The positive rate of C1 q deposition in kidney tissues in the low titer group was higher than that in the negative group,and the difference was statistically significant(P=0.047).Other pathological indicators were no statistical differences.3、The sensitivity of serum anti-PLA2 R antibody to diagnose IMN is 67.57%,and the sensitivity of PLA2 R in kidney tissue to diagnose IMN is 86.04%.There were 134 patientswith positive anti-PLA2 R antibodies in serum and kidney tissues,the positive rate was 60.36%.There were 207 patients with anti-PLA2 R antibodies or PLA2 R antigen positive in kidney tissues,and the positive rate of combined diagnosis was 93.24%.4、Serum anti-PLA2 R antibody titers were positively correlated with age、24h urine protein quantification、Scr、TG、FIB and DD,and negatively correlated with TP、ALB、ALT and eGFR(P<0.05).There was no correlation between serum anti-PLA2 R titers and other clinical indicators such as Hb、RBC/HP、WBC/HP、SG、BUN、uric acid(P>0.05).5、A total of 194 patients were followed up.The total remission rate of the positive group was 51.51%,and the total remission rate of the negative group was 70.97%.The difference was statistically significant(P<0.01).In the anti-PLA2 R antibody positive group,17 patients relapsed after remission,while in the anti-PLA2 R antibody negative group,there was no relapse after remission.The difference between the two groups was statistically significant(P<0.01).There was no statistical difference in the time to achieve partial and complete response between the two groups.The BUN、Scr and cystatin C of the remission group in the positive group were lower than those in the non-remission group,and the difference was statistically significant(P<0.05),while the eGFR in the remission group was higher than that in the non-remission group,and the difference was also statistically significant(P=0.029).Age was the risk factor for unresponsiveness in the positive group.OR(95% CI)is 1.036(1.001,1.073)(P=0.046).In the negative group,the Scr in the remission group was higher than that in the non-remission group,and the difference was statistically significant(P = 0.002).The proportion of males in the remission group was higher than in the non-remission group,and the gender difference between the two groups was statistically significant(P=0.033).Scr was the protective factor for unresponsiveness in the negative group(P=0.006).Conclusion 1、The level of serum anti-PLA2 R antibody titers can reflect the severity and activity of IMN.2、The C3 deposition in kidney tissue of seropositive group was significantly higher than that of seropositive group.Serum anti-PLA2 R antibody is not only a biomarker for the clinical manifestations of IMN,but also a good indicator of the pathological characteristics of IMN.3、The combined diagnosis of serum and kidney tissue can improve the positive diagnosis rate but cannot replace each other.In addition,5.41% of patients had negative serum PLA2 R antibodies and renal PLA2 R,indicating that double negatives cannot completely exclude IMN,which may be related to other podocyte cell proteins of IMN.4、Serum anti-PLA2 R antibody titers were positively correlated with age、24h urine protein quantification、Scr、TG、FIB and DD,and negatively correlated with TP、ALB、ALT and eGFR.5、Serum PLA2 R antibodies may be related to poor prognosis outcomes.The BUN、 Scr and cystatin C in the remission group in the positive group were lower than those in the non-remission group,while the eGFR was higher than that in the non-remission group.Regression analysis showed that age was a risk factor for non-remission in the positive group.