本文選題：特發(fā)性膜性腎病 + 抗PLA2R抗體　； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過單中心隊列研究探討血清抗磷脂酶A2受體(phospholipase A2-receptor,PLA2R)抗體在評價特發(fā)性膜性腎病(Idiopathic Membranous Nephropathy,IMN)患者預(yù)后中的作用。方法:1.選取2011年3月至2016年2月首次在北京大學(xué)深圳醫(yī)院腎內(nèi)科住院行腎穿刺活檢,病理診斷為IMN患者259例,其中男性142例,女性117例,平均年齡為41.75±14.45歲,并對這些患者進(jìn)行隨訪,隨訪時間截止至2016年7月(其中隨訪血清收集時間為2015年7月至2016年7月)。2.收集患者基線及隨訪資料,包括一般資料如性別,發(fā)病年齡、活檢時年齡等,及臨床生化指標(biāo)如尿常規(guī)、隨機(jī)尿蛋白/肌酐比值、24小時尿蛋白定量、血白蛋白(serum albumin,ALB)、血肌酐(serum creatinine,Scr)、估計腎小球濾過率(estimate glomerular filtration rate,e GFR)、尿素氮(blood urea nitrogen,BUN)、甘油三酯(triglyceride,TG)、總膽固醇(total cholesterol,TC)、隨訪過程中治療情況。3.利用間接酶聯(lián)免疫吸附法(enzyme linked immunosorbent assay,ELISA)檢測259例IMN患者腎穿當(dāng)天及部分患者隨訪過程中血清抗PLA2R抗體滴度,其中20RU/ml為陰性,20RU/ml為陽性結(jié)果,根據(jù)血清抗PLA2R抗體滴度分為陽性組和陰性組。4.應(yīng)用SPSS 19.0及Stata 14.0軟件進(jìn)行統(tǒng)計學(xué)分析,P0.05代表差異有統(tǒng)計學(xué)意義。結(jié)果:1.259例IMN患者中抗PLA2R抗體陽性患者133例,陽性率為51.35%�？贵w陽性組較陰性組患者血ALB低,尿蛋白高、年齡較大(P0.05),而兩組患者間性別、Scr、e GFR并無統(tǒng)計學(xué)意義(P0.05)。簡單線性相關(guān)分析發(fā)現(xiàn)抗體滴度與蛋白尿呈正相關(guān),與血ALB呈負(fù)相關(guān)(P0.001)。2.166例完成隨訪,隨訪中位時間24個月,其中男性95例,女性71例,血清抗體陽性率為53.01%。隨訪過程中所有患者都使用支持治療,僅有62例患者使用免疫抑制劑。兩組間年齡、性別、Scr、e GFR、隨訪時間、是否接受免疫抑制劑治療無統(tǒng)計學(xué)差異(P0.05),陽性組較陰性組的血ALB較低、尿蛋白量高(P0.05)。3.166例IMN患者隨訪中位時間24個月后,68例獲得完全緩解,73例自發(fā)緩解,進(jìn)入終末期腎臟病的患者0例。統(tǒng)計分析結(jié)果提示陰性組的完全緩解率及自發(fā)緩解率高于陽性組(52.56 VS 30.68%,P=0.001及56.72 VS 44.87%,P=0.02),Kaplan-Meier曲線也提示陰性組患者達(dá)到完全緩解早于陽性組。通過COX回歸分析,調(diào)整了年齡、性別、ALB、Scr、尿蛋白等混雜因素后,發(fā)現(xiàn)基線抗體滴度升高是影響IMN疾病完全緩解的風(fēng)險因子,抗體滴度每升高10RU/ml,IMN未達(dá)到完全緩解風(fēng)險增加54%。比較疾病活動不同的三組,發(fā)現(xiàn)疾病活動組抗體滴度平均數(shù)明顯高于完全緩解和部分緩解組,疾病活動組患者較完全緩解組年齡較大、男性所占比例較高、隨訪中接受免疫抑制劑治療的患者比例高。4.對27例患者隨訪12月,觀察到抗PLA2R抗體滴度下降或轉(zhuǎn)陰早于蛋白尿。結(jié)論:1.我中心IMN患者中血清抗PLA2R抗體陽性率為51.35%�？贵w陽性組患者較陰性組血白蛋白低、尿蛋白高。2.隨訪中位時間24個月,我中心IMN患者完全緩解率52.56%,自發(fā)緩解率50.34%,其中進(jìn)入終末期腎臟病患者0例�？筆LA2R抗體陰性組完全緩解率及自發(fā)緩解率高于陽性組。COX回歸分析提示基線抗體滴度升高是IMN疾病不能完全緩解的風(fēng)險因子,抗體滴度每升高10RU/ml,IMN患者未達(dá)到完全緩解的風(fēng)險增加54%。3.抗PLA2R抗體滴度下降或轉(zhuǎn)陰早于蛋白尿,監(jiān)測血清抗PLA2R抗體滴度是監(jiān)測疾病活動及治療效果更敏感的指標(biāo)。
[Abstract]:Objective: To investigate the role of serum anti phospholipase A2 receptor (phospholipase A2-receptor, PLA2R) antibody in the evaluation of the prognosis of patients with idiopathic membranous nephropathy (Idiopathic Membranous Nephropathy, IMN) by single center cohort study. Methods: 1. to choose the first renal biopsy in the Department of Nephrology of Shenzhen hospital, Peking University, from March 2011 to February 2016. Biopsy and pathological diagnosis were performed in 259 IMN patients, including 142 males and 117 females with an average age of 41.75 + 14.45 years of age. The follow-up period was followed up to July 2016 (in which the follow-up period was from July 2015 to July 2016).2. collected the patients' baseline and follow-up data, including general data such as sex, and the onset of the disease. Age, age of biopsy, and clinical biochemical parameters such as urine routine, random urine protein / creatinine ratio, 24 hour urine protein quantitative, serum albumin, ALB, serum creatinine, Scr, estimated glomerular filtration rate (estimate glomerular filtration rate, e GFR), urea nitrogen, triglyceride IDE, TG), total cholesterol (total cholesterol, TC), and in the follow-up process,.3. was detected by indirect enzyme linked immunosorbent assay (enzyme linked immunosorbent assay, ELISA) in 259 cases of kidney penetration and some patients. LA2R antibody titer was divided into positive group and negative group.4. application SPSS 19 and Stata 14 software for statistical analysis. The difference of P0.05 representative was statistically significant. Results: 1.259 cases of IMN patients with positive anti PLA2R antibody were 133 cases, the positive rate was lower in 51.35%. antibody positive group than in negative group, and the urine protein was high, and the age was larger (P0.05), but two The gender, Scr, and E GFR were not statistically significant (P0.05). Simple linear correlation analysis found that the antibody titer was positively correlated with proteinuria and was negatively correlated with blood ALB (P0.001).2.166 cases completed for 24 months, including 95 males and 71 females, and the positive rate of serum antibody was used in all patients during the follow-up of 53.01%.. Support therapy, only 62 patients were treated with immunosuppressive agents. Two groups of age, sex, Scr, e GFR, follow-up time, no statistical difference in the treatment of immunosuppressive agents (P0.05), the positive group was lower than the negative group, the urine protein was high (P0.05).3.166 case IMN patients were followed up at the median time of 24 months, 68 cases had complete remission, 73 cases spontaneous. The results of 0 patients with end-stage renal disease showed that the rate of complete remission and spontaneous remission in the negative group was higher than that of the positive group (52.56 VS 30.68%, P=0.001 and 56.72 VS 44.87%, P=0.02), and the Kaplan-Meier curve suggested that the negative group had complete remission earlier than the positive group. The age, sex and sex were adjusted by the COX regression analysis. ALB, Scr, urinary protein and other confounding factors, it was found that the increase in the titer of the baseline antibody was a risk factor for the complete remission of the IMN disease. The antibody titer increased by 10RU/ml, and the IMN did not reach the total remission risk, which increased the 54%. comparison of the disease activity in three groups, and found that the average number of antibody titers in the disease group was significantly higher than that of the complete remission and the partial delay. The patients in the group of disease active group were older than the complete remission group, and the proportion of men was higher. The proportion of patients receiving immunosuppressive therapy in the follow-up was high.4. to 27 patients followed up in December. The anti PLA2R antibody titer decreased or turned negative to proteinuria. Conclusion: 1. the positive rate of serum anti PLA2R antibody in IMN patients in the center of my center is 51.35%. anti 51.35%.. In the positive group, the blood albumin was low in the negative group and the high.2. follow-up time was 24 months. The complete remission rate was 52.56%, the spontaneous remission rate was 50.34%, of which 0 were in the end-stage renal disease. The complete remission rate and spontaneous remission rate of the anti PLA2R negative group were higher than the positive group.COX regression analysis suggested the baseline antibody drop. The increase of degree is a risk factor for IMN disease, and the antibody titer increases by 10RU/ml. The risk of IMN patients not reaching complete remission increases the drop of 54%.3. anti PLA2R antibody titer or turns negative to proteinuria. The monitoring of serum anti PLA2R antibody titer is a more sensitive indicator for monitoring disease activity and treatment effect.

【學(xué)位授予單位】：安徽醫(yī)科大學(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3條

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本文編號：1817837