摘要
目的评估抗M型磷脂酶A2受体(PLA2R)抗体阳性在我国老年人群中替代肾活检诊断特发性膜性肾病(IMN)的可行性。方法收集2021年6月至2022年3月在郑州大学第一附属医院肾内科就诊,抗PLA2R抗体阳性(酶联免疫吸附实验≥14 RU/ml)且有完整肾脏病理资料并排除继发因素及糖尿病的96例老年肾病患者(≥60岁)的临床病理资料,分为高估算肾小球滤过率(高eGFR组,≥60 ml·min^(-1)·1.73m^(-))和低eGFR组(<60 ml·min^(-1)·1.73m^(-))。结果96例患者中IMN 95例占99.0%(其中Ⅰ期1例、Ⅱ期59例、Ⅲ期34例、Ⅳ期1例),不典型膜性肾病(AMN)1例(1.0%)。IMN患者中高eGFR组81例(85.3%),以Ⅱ期IMN最多见(66.7%),其中10例(12.3%)合并其他病理表现,以轻度系膜增生性IgA肾病(2例)、亚急性肾小管间质性肾病(2例)最多见;低eGFR组IMN患者14例(14.7%),Ⅲ期IMN最多见(57.1%),其中10例(71.4%)合并其他病理表现,高于高eGFR组(χ^(2)=21.642,P<0.05),以急性肾小管损伤(4例)、缺血性肾损伤(2例)最多见。结论对于我国老年患者,抗PLA2R抗体阳性高度预测IMN,但合并其他病理诊断较多,需对肾活检检出其他病理诊断的优势及其操作风险进行权衡。
Objective To evaluate the feasibility of using positive anti-M-type phospholipase A2 receptor(PLA2R)antibody detection as a surrogate for renal biopsy in the diagnosis of idiopathic membranous nephropathy(IMN)in elderly Chinese.Methods From June 2021 to March 2022,clinicopathological data of ninety-six elderly patients(≥60 years old)with positive anti-PLA2R antibody detection(ELISA≥14 RU/ml),complete renal pathology records,and the exclusion of secondary disease and diabetes mellitus were collected from the Department of Nephrology,The First Affiliated Hospital of Zhengzhou University.Patients were divided into high eGFR group(≥60 ml·min^(-1)·1.73m^(-))and low eGFR group(<60 ml·min^(-1)·1.73m^(-)),and the data were analyzed retrospectively.Results Of the 96 patients,95(99.0%)had IMN(1 in stageⅠ,59 in stageⅡ,34 in stageⅢ,and 1 in stageⅣ),and 1(1.0%)had atypical membranous nephropathy(AMN).For the IMN patients,81(85.3%)had high eGFR and most IMN patients(66.7%)were in stageⅡ,with 10(12.3%)showing additional pathological findings,including mild mesangial proliferative IgA nephropathy(2 cases)and subacute tubulointerstitial nephropathy(2 cases).There were 14 patients(14.7%)with low eGFR,and most of them(57.1%)had stageⅢIMN,with 10(71.4%)showing additional pathological findings.This percentage was higher than that in the high eGFR group(χ^(2)=21.642,P<0.05).The most common additional pathological findings were acute tubular injury(4 cases)and ischemic kidney injury(2 cases).Conclusions Positive anti-PLA2R antibody detection is highly predictive of IMN in elderly Chinese patients,but it often co-exists with other pathological entities.The advantages of renal biopsy in detecting other pathological conditions and the risks associated with the procedure should be evaluated.
作者
卢珊
董奕君
张艳
肖静
赵占正
Lu Shan;Dong Yijun;Zhang Yan;Xiao Jing;Zhao Zhanzheng(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2023年第10期1196-1200,共5页
Chinese Journal of Geriatrics
基金
河南省科技攻关计划项目(212102310772)
河南省高等学校重点科研项目计划(22A320078)
河南省医学科技攻关计划省部共建重点项目(SBGJ202102154)。
关键词
肾小球肾炎
膜性
磷脂酶A2
抗体
Glomerulonephritis,membranous
Phospholipase A2
Antibody
