本文選題：特發(fā)性膜性腎病　切入點：M型磷脂酶A2受體　出處：《青島大學(xué)》2017年碩士論文

【摘要】：研究目的:特發(fā)性膜性腎病(IMN)是一組以腎病綜合征為主要臨床表現(xiàn)、以腎小球基底膜受損為主要病理特征的,好發(fā)于40~50歲人群的腎小球疾病。近年來學(xué)者們研究發(fā)現(xiàn)約有74%的IMN患者腎組織可檢測到M型磷脂酶A2受體(M-type phospholipase A2 receptor,PLA2R),并且發(fā)現(xiàn)了相應(yīng)的抗體,然而兩者如何參與IMN的發(fā)病機制尚不明確。本研究目的是探討兩者在IMN中表達的相關(guān)性以及兩者與IMN的診斷、疾病活動、預(yù)后的關(guān)系。研究方法:1.選取2016年3月至2016年12月收治于青島大學(xué)附屬醫(yī)院腎病科并行腎穿刺活檢后確診為IMN的36例患者作為觀察組,微小病變腎病、狼瘡性腎炎、Ig A腎病等非IMN的其他腎小球疾病共14例作為對照組,分析兩組間一般臨床資料以及白蛋白水平、24小時尿蛋白定量、血肌酐等可反映腎臟受損程度的指標的差異。2.使用免疫組織化學(xué)染色法檢測兩組患者腎組織PLA2R的表達,使用ELISA法檢測血清抗PLA2R抗體的滴度,計算兩者在不同組的陽性率,并在IMN組中分析兩者的相關(guān)性。3.使用SPSS統(tǒng)計軟件制作受試者工作特征曲線(ROC),分析PLA2R及其抗體對IMN診斷的準確性。4.分別在IMN組中分析PLA2R以及其抗體的陽性表達與腎臟受損程度的關(guān)系。5.在PLA2R全部為陽性的IMN患者中,分抗體陽性組與陰性組,并比較兩組間腎臟受損程度的不同。6.分析IMN組中抗體滴度與疾病活動水平的關(guān)系。7.收集治療時間超過3個月的IMN組的33例患者的隨訪資料,分析PLA2R以及其抗體與預(yù)后的關(guān)系。研究結(jié)果:IMN組與對照組間發(fā)病年齡、性別、血壓、24小時尿蛋白定量、血清白蛋白、血清肌酐等指標均無顯著性差異(p0.05),腎組織PLA2R及其抗體的陽性檢出均有統(tǒng)計學(xué)差異。1.PLA2R診斷IMN的靈敏度是75.00%,特異度是85.71%;PLA2R抗體診斷IMN的靈敏度是63.89%,特異度是92.86%;PLA2R聯(lián)合抗體診斷IMN的靈敏度是75.00%,特異度是78.57%。2.PLA2R抗體曲線下面積(AUCROC)是0.784,腎組織PLA2R的AUCROC是0.875。3.IMN組中血清PLA2R抗體陽性與陰性患者的血清肌酐間的差異無統(tǒng)計學(xué)意義(p0.05),24小時尿蛋白定量分別是5.56±2.80 g/24h和3.79±1.04 g/24h(p=0.011),血清白蛋白分別是21.23±4.79 g/L和24.41±3.83 g/L(p=0.037),均有顯著性差異;IMN組中腎組織PLA2R陽性組與陰性組的肌酐、24小時尿蛋白定量、血清白蛋白均無顯著性差異。4.PLA2R全部陽性的IMN患者中,抗體陽性組與陰性組間的肌酐、白蛋白、24小時尿蛋白定量均無顯著性差異。5.IMN中患者抗體滴度與其24小時尿蛋白定量呈正相關(guān)(r=0.874,p0.001),與血清白蛋白水平呈負相關(guān)(r=-0.779,p0.001)。6.經(jīng)免疫抑制治療3個月后,腎組織PLA2R陽性組與陰性組的緩解率分別是41.7%和66.7%,用Fisher確切概率法計算其p0.05,無顯著性差異;抗體陽性組與陰性組的緩解率分別是33.3%和75%,用Fisher確切概率法計算其p=0.025,PLA2R抗體陰性組的緩解情況優(yōu)于PLA2R抗體陽性組。研究結(jié)論:腎組織PLA2R及其血清抗體在IMN中的表達并不完全一致,腎組織PLA2R陽性表達的患者,其抗體可為陰性。腎組織PLA2R及其抗體對IMN的診斷具有良好的靈敏度和特異度,有較高的疾病診斷價值。PLA2R與IMN疾病程度無相關(guān)性,PLA2R抗體的表達可反應(yīng)腎臟損傷程度。另外,抗體滴度與尿蛋白定量及血白蛋白水平呈線性關(guān)系。IMN中抗體陽性的患者治療的反應(yīng)均不如陰性患者。
[Abstract]:Objective: idiopathic membranous nephropathy (IMN) is a group of nephrotic syndrome is the main clinical manifestation, glomerular basement membrane damage is the main pathological features, good hair at 40~50 year old population of glomerular diseases. In recent years many scholars have found that about 74% of the renal tissue of patients with IMN can be detected by M phospholipase A2 receptor (M-type phospholipase A2 receptor, PLA2R), and found the corresponding antibody, however the pathogenesis of both how to participate in IMN is not clear. The purpose of this study is to investigate the correlation between the expression of diagnosis, both in IMN and the two with IMN disease activity, the relationship between the prognosis. Methods: from March 2016 to 1. from December 2016 to the concurrent Department of nephropathy of Affiliated Hospital of Qiingdao University after the renal biopsy, 36 cases were diagnosed as IMN patients as the observation group, nephropathy, lupus nephritis, nephropathy and other non Ig A IMN other glomerular diseases A total of 14 cases as control group, analysis of two groups of general clinical data and serum albumin levels, 24 hour urinary protein quantitative immunohistochemical staining method was used to detect the expression of PLA2R in renal tissue of two patients with different.2. blood creatinine can reflect the degree of kidney damage index, titer of anti PLA2R antibody in serum was detected by ELISA. The positive rate calculated in different groups, and in IMN group the correlation analysis of.3. using the SPSS statistical software to make the receiver operating characteristic curve (ROC) analysis, PLA2R and its antibody on the diagnostic accuracy of.4. IMN respectively in the IMN group and the relationship between the positive expression of.5. PLA2R analysis of the antibody and the degree of kidney damage. In all PLA2R positive IMN patients, divided into positive group and negative group, and compared between the two groups of different.6..7. relationship between the kidney damage group IMN antibodies and the disease activity level analysis degree Collect the treatment time more than 3 months IMN group of 33 patients with follow-up data, analysis of PLA2R and its relationship with prognosis. Antibody results: IMN group and control group, age, gender, blood pressure, 24 hour urinary protein, serum albumin, and there were no significant differences in serum creatinine (P0.05), and PLA2R antibody positive detection sensitivity of renal tissue were statistically significant.1.PLA2R in the diagnosis of IMN was 75%, the specificity was 85.71%; the sensitivity of PLA2R antibody in the diagnosis of IMN was 63.89%, the specificity was 92.86%; PLA2R combined with IMN antibody diagnostic sensitivity was 75%, specificity of 78.57%.2.PLA2R antibody under the curve area (AUCROC) is in 0.784, PLA2R in renal tissue AUCROC is no statistically significant difference in serum creatinine in 0.875.3.IMN group serum PLA2R antibody positive and negative patients between (P0.05), 24 hour urinary protein quantitative difference is 5.56 + 2.80 g/24h and 3.79 1.04 g/24h (p=0.011), serum albumin were 21.23 + 4.79 and 24.41 + 3.83 g/L g/L (p=0.037), there were significant differences in renal tissue in the IMN group; PLA2R positive group and negative group serum creatinine, urine protein in 24 hours, there were no significant differences in serum albumin.4.PLA2R positive IMN patients, creatinine, antibody positive group and negative group of albumin, there were no significant differences between the 24 hour urinary protein quantitative.5.IMN in patients with antibody titers and 24 hours urine protein was positively correlated (r=0.874, p0.001), and negatively correlated with serum albumin level (r=-0.779, p0.001).6. after immunosuppressive therapy after 3 months renal tissue PLA2R positive group and negative group remission rate were 41.7% and 66.7%, calculate the P0.05 Fisher exact method, no significant difference; positive group and negative group remission rates were 33.3% and 75%, Fisher's exact test was used to calculate the P=0.025, relief is better than that of the PLA2R antibody positive group PLA2R antibody negative group. Conclusion: the expression of PLA2R in renal tissue and serum antibody in IMN is not exactly the same, the positive expression of PLA2R in renal tissue of patients, the antibody was negative. Has good sensitivity and specificity in the diagnosis of PLA2R and antibody in kidney tissue of the IMN. Have a higher disease diagnosis value of.PLA2R and IMN had no correlation with the extent of the disease, the expression of PLA2R antibody can reflect the degree of renal damage. In addition, albumin level and the titer of urinary protein and serum antibody showed a linear relationship between.IMN antibodies in patients with positive response to treatment were better than negative patients.

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692

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相關(guān)期刊論文 前1條

1 周廣宇;金玲;于晶;張芝平;;成人膜性腎病患者血清抗PLA2R抗體與病情的相關(guān)性[J];中華腎臟病雜志;2012年02期

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本文編號：1699795