血清aPLA2Rab评估PLA2R相关膜性肾病患者病情和预后的价值
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1.苏州大学附属第一医院 肾内科;2.南京医科大学附属苏州医院(苏州市立医院北区)ICU

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苏州市卫生健康委员会科技项目 LCZX202002


The value of serum aPLA2Rab in evaluating the severity and prognosis of patients with PLA2R-related membranous nephropathy
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Suzhou Municipal Health Commission Science and Technology Project LCZX202002

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    摘要:

    目的:在PLA2R相关膜性肾病患者中观察血清aPLA2Rab滴度与肾脏疾病严重程度以及肾脏预后的关系。方法:纳入苏州大学附属第一医院肾内科经肾活检证实为PLA2R相关膜性肾病,且随访时间≥1年的患者。观察终点为肾功能不全,定义为估计肾小球滤过率(eGFR)较基线下降40%。结果:本研究共纳入273例患者。血清aPLA2Rab滴度<50RU/ml组44例(低滴度组)、50~150RU/ml组142例(中滴度组)、>150RU/ml组87例(高滴度组)。血清aPLA2Rab滴度与性别、血清肌酐、总胆固醇、尿NAG、尿RBP、肾小球C4沉积显著正相关,与血清白蛋白显著负相关。血清aPLA2Rab滴度为肾功能不全的独立危险因素,aPLA2Rab滴度预测肾功能不全的截点值为135.66RU/ml。1年、5年和10年未达肾功能不全的肾脏生存率低滴度组均为100%;中滴度组分别为100%、87.0%和75.5%;高滴度组分别为95.4%、72.3%和72.3%;三组有显著差异。结论: PLA2R相关膜性肾病患者血清中aPLA2Rab滴度水平与肾脏疾病严重程度以及肾脏预后相关,为以免疫学缓解为治疗目标的新理念提供理论支持。

    Abstract:

    Objective: To observe the relationship between serum aPLA2Rab titer and the severity of renal disease and renal prognosis in patients with PLA2R-related membranous nephropathy. Methods: Patients with PLA2R-related membranous nephropathy confirmed by renal biopsy in the Department of Nephrology of the First Affiliated Hospital of Soochow University were included and were followed up for ≥1 year. The end point was renal insufficiency, defined as a 40% decrease of eGFR from baseline. Results: A total of 273 patients were included in this study, of which serum aPLA2Rab titer <50RU/ml group (low titer group) had 44 cases, 50-150RU/ml group (medium titer group) 142 cases and >150RU/ml group (high titer group) 87 cases. Serum aPLA2Rab titers were significantly correlated with gender, baseline serum albumin, serum creatinine, total cholesterol, urinary NAG, urinary RBP, and glomerular C4 deposition. Multivariate Cox analysis showed that aPLA2Rab titer was still an independent risk factor for renal insufficiency after correction for clinicopathological parameters. The cutoff point of serum aPLA2Rab titers for predicting renal insufficiency was 135.66RU/ml, with a sensitivity of 65.8% and a specificity of 63.8%. The renal survival rates without reaching renal insufficiency at 1 year, 5 years and 10 years were all 100% in the low titer group; 100%, 87.0% and 75.5% in the medium titer group; 95.4%, 72.3% and 72.3% in the high titer group respectively; there was a significant difference among the three groups. Conclusion: This study further confirmed that the serum aPLA2Rab titer level in patients with PLA2R-related membranous nephropathy was related to disease severity and renal prognosis, providing theoretical support for the new concept of immunological remission as the therapeutic target.

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  • 收稿日期:2022-03-21
  • 最后修改日期:2022-09-07
  • 录用日期:2023-05-10
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