Page 132 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第43卷第5期
·714 · Journal of Nanjing Medical University（Natural Sciences） 2023年5月

·临床研究·

血清aPLA2Rab评估PLA2R相关膜性肾病患者病情和预后的价值

杨 静 ，杨爱祥 ，沈 蕾 ，沙文刚 ，徐德宇 ，李建中 ，卢国元 1*
1
1
1
1
1，2
1
苏州大学附属第一医院肾内科，江苏 苏州 215000；南京医科大学附属苏州医院（苏州市立医院北区）重症监护室，江苏
1 2
苏州 215008
［摘 要］ 目的：在磷脂酶A2受体（PLA2R）相关膜性肾病患者中观察血清抗磷脂酶A2受体抗体（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
的患者共计273例。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%。收集患者各项临床检测指标
进行统计学分析。结果：血清aPLA2Rab滴度<50 RU/mL组44例（低滴度组）、50~＜150 RU/mL组142例（中滴度组）、≥150 RU/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135.66 RU/mL。
1、5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%；3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。
［关键词］ 膜性肾病；磷脂酶A2受体；预后；危险因素
［中图分类号］ R586 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）05⁃714⁃06
doi：10.7655/NYDXBNS20230518

The value of serum aPLA2Rab in evaluating the severity and prognosis of patients with
PLA2R⁃related membranous nephropathy

1 1，2 1 1 1 1 1*
YANG Jing ，YANG Aixiang ，SHEN Lei ，SHA Wengang ，XU Deyu ，LI Jianzhong ，LU Guoyuan
1 Department of Nephrology，the First Affiliated Hospital of Soochow University，Suzhou 215000；Intensive Care Unit，
2
Suzhou Hospital Affiliated to Nanjing Medical University（North District of Suzhou State Hospital），Suzhou 215008，
China

［Abstract］ Objective：To observe the relationship between serum aPLA 2Rab titer and the severity of renal disease and renal
prognosis in patients with PLA 2R⁃related membranous nephropathy. Methods：A total of 237 patients with PLA 2R⁃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.
Clinical indicators of patients were collected for statistical analysis. Results：A total of 273 patients were included in the current study，
of which serum aPLA 2Rab titer <50 RU/mL group（low titer group）had 44 cases，50~＜150 RU/mL group（medium titer group）142 cases
and ≥150 RU/mL group（high titer group）87 cases. Serum aPLA 2Rab 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 aPLA 2Rab titers for predicting renal insufficiency was 135.66 RU/mL，with a sensitivity of 65.8% and a specificity of
63.8%. The renal survival rates without reaching renal insufficiency at 1，5 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：The current study further confirmed that the serum aPLA 2Rab titer level in patients with
PLA2R⁃related membranous nephropathy was related to disease severity and renal prognosis，providing theoretical support for the new

［基金项目］ 苏州市卫生健康委员会科技项目（LCZX202002）
∗
通信作者（Corresponding author），E⁃mail：sdfyylgy@163.com