血清抗磷脂酶A2受體抗體在特發(fā)性膜性腎病診斷中的意義以及免疫抑制治療的療效觀察
發(fā)布時間：2018-10-26 15:29
【摘要】：目的:探討血清抗磷脂酶A2受體(anti-phospholipase A2 receptor,PLA2R)抗體診斷特發(fā)性膜性腎病(Idiopathic Membranous Nephropathy,IMN)的價值以及他克莫司(tacrolimus,TAC)與環(huán)磷酰胺(cyclophosvnamide,CTX)治療IMN的療效比較。方法:收集2015年4月至2016年11月就診于新疆醫(yī)科大學(xué)第一附屬醫(yī)院腎病科,同時行腎穿刺活檢及血清抗PLA2R抗體檢測的282例患者,采用靈敏度、特異度、Kappa系數(shù)等指標分析血清抗PLA2R抗體水平與腎活檢組織病理診斷結(jié)果的相關(guān)性。以及對經(jīng)他克莫司治療和經(jīng)環(huán)磷酰胺治療的IMN患者,定期監(jiān)測24h尿蛋白定量、血漿白蛋白、血白細胞、腎功能、血脂等指標,對患者治療期間的緩解率等進行觀察。結(jié)果:1)同時行腎穿刺活檢及血清抗PLA2R抗體檢測的282例患者中,男性人數(shù)多于女性(男性=149例,女性=133例,各占52.8%、47.2%);漢族人數(shù)多于少數(shù)民族(漢族162例,維吾爾族81例,其他民族39例);年齡分布區(qū)間為14-72歲,平均年齡為(38.95±12.79)歲。性別、民族在IMN組與非特發(fā)性膜性腎病(Non-Idiopathic Membranous Nephropathy,Non-IMN)組間無統(tǒng)計學(xué)差異,P0.05;2)282例腎活檢患者中,100例病理診斷為膜性腎病,其中78例抗PLA2R抗體陽性、22例陰性,而該抗體在腎穿刺確診為非IMN的182例患者中,僅有2例陽性。該抗體檢測IMN的靈敏度為78.0%;特異度為98.9%;血清抗磷脂酶A2受體(PLA2R)抗體診斷膜性腎病的符合率為78.0%。3)治療前,TAC組與CTX組的24h尿蛋白定量、血漿白蛋白、血白細胞、腎功能、血脂等指標的差異均無統(tǒng)計學(xué)意義(P0.05);兩組治療3個月、6個月后,24h尿蛋白定量及血漿白蛋白水平較治療前明顯好轉(zhuǎn)(P0.05);治療6個月后,TAC組與CTX組相比,24h尿蛋白定量較低,血漿白蛋白較高,差異均有統(tǒng)計學(xué)意義(均P0.05)。4)治療6個月,TAC組的部分緩解率及總緩解率明顯高于CTX組(P0.05)。結(jié)論:血清抗PLA2R抗體可作為IMN的特異性標志物,可用于疾病的診斷,是有潛力的診斷治療指標。TAC和CTX對IMN的治療均有一定的療效;治療6個月時,TAC的療效及緩解率明顯優(yōu)于CTX。
[Abstract]:Objective: to evaluate the value of serum anti-phospholipase A2 receptor (anti-phospholipase A2 receptor,PLA2R) antibody in the diagnosis of idiopathic membranous nephropathy (Idiopathic Membranous Nephropathy,IMN) and to compare the efficacy of tacrolimus (tacrolimus,TAC) and cyclophosphamide (cyclophosvnamide,CTX) in the treatment of IMN. Methods: from April 2015 to November 2016, 282 patients with renal diseases in the first affiliated Hospital of Xinjiang Medical University were examined by renal biopsy and serum anti PLA2R antibody. The correlation between serum anti-PLA2R antibody level and pathological diagnosis of renal biopsy was analyzed by Kappa coefficient. IMN patients treated with tacrolimus and cyclophosphamide were regularly monitored for 24 hours urinary protein quantification, plasma albumin, white blood cell, renal function and blood lipid, and the remission rate during treatment was observed. Results: 1) the number of males was higher than that of females (male = 149, female = 133, 52.8%). The number of Han nationality is more than that of minority nationality (162 cases of Han nationality, 81 cases of Uygur nationality, 39 cases of other nationalities), the age distribution range is 14-72 years old, the average age is (38.95 鹵12.79) years old. There was no significant difference in sex and nationality between IMN group and non-idiopathic membranous nephropathy (Non-Idiopathic Membranous Nephropathy,Non-IMN) group (P 0.05). 2) of 282 renal biopsy patients, 100 cases were diagnosed as membranous nephropathy, of which 78 cases were positive for anti PLA2R antibody, 22 cases were negative, but only 2 cases were positive in 182 cases of non IMN diagnosed by renal biopsy. The sensitivity of the antibody for detecting IMN was 78.0 and the specificity was 98.9. The coincidence rate of serum anti-phospholipase A2 receptor (PLA2R) antibody in the diagnosis of membranous nephropathy was 78.0.3) before treatment, 24 hours urine protein, plasma albumin, white blood cell, renal function were measured in TAC group and CTX group. There was no significant difference in blood lipid and other indexes (P0.05). After treatment for 3 months and 6 months, 24 h urinary protein and plasma albumin levels were significantly improved in both groups (P0.05). After 6 months of treatment, compared with CTX group, 24 hours urine protein quantity was lower and plasma albumin was higher in TAC group than that in CTX group, the difference was statistically significant (P0.05) for 6 months. The partial remission rate and total remission rate of TAC group were significantly higher than that of CTX group (P0.05). Conclusion: serum anti PLA2R antibody can be used as a specific marker of IMN, can be used in the diagnosis of disease, and is a potential diagnostic and therapeutic index. Both TAC and CTX have a certain therapeutic effect on IMN. After 6 months of treatment, the curative effect and remission rate of TAC were significantly better than those of CTX..
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692
本文編號：2296172
[Abstract]:Objective: to evaluate the value of serum anti-phospholipase A2 receptor (anti-phospholipase A2 receptor,PLA2R) antibody in the diagnosis of idiopathic membranous nephropathy (Idiopathic Membranous Nephropathy,IMN) and to compare the efficacy of tacrolimus (tacrolimus,TAC) and cyclophosphamide (cyclophosvnamide,CTX) in the treatment of IMN. Methods: from April 2015 to November 2016, 282 patients with renal diseases in the first affiliated Hospital of Xinjiang Medical University were examined by renal biopsy and serum anti PLA2R antibody. The correlation between serum anti-PLA2R antibody level and pathological diagnosis of renal biopsy was analyzed by Kappa coefficient. IMN patients treated with tacrolimus and cyclophosphamide were regularly monitored for 24 hours urinary protein quantification, plasma albumin, white blood cell, renal function and blood lipid, and the remission rate during treatment was observed. Results: 1) the number of males was higher than that of females (male = 149, female = 133, 52.8%). The number of Han nationality is more than that of minority nationality (162 cases of Han nationality, 81 cases of Uygur nationality, 39 cases of other nationalities), the age distribution range is 14-72 years old, the average age is (38.95 鹵12.79) years old. There was no significant difference in sex and nationality between IMN group and non-idiopathic membranous nephropathy (Non-Idiopathic Membranous Nephropathy,Non-IMN) group (P 0.05). 2) of 282 renal biopsy patients, 100 cases were diagnosed as membranous nephropathy, of which 78 cases were positive for anti PLA2R antibody, 22 cases were negative, but only 2 cases were positive in 182 cases of non IMN diagnosed by renal biopsy. The sensitivity of the antibody for detecting IMN was 78.0 and the specificity was 98.9. The coincidence rate of serum anti-phospholipase A2 receptor (PLA2R) antibody in the diagnosis of membranous nephropathy was 78.0.3) before treatment, 24 hours urine protein, plasma albumin, white blood cell, renal function were measured in TAC group and CTX group. There was no significant difference in blood lipid and other indexes (P0.05). After treatment for 3 months and 6 months, 24 h urinary protein and plasma albumin levels were significantly improved in both groups (P0.05). After 6 months of treatment, compared with CTX group, 24 hours urine protein quantity was lower and plasma albumin was higher in TAC group than that in CTX group, the difference was statistically significant (P0.05) for 6 months. The partial remission rate and total remission rate of TAC group were significantly higher than that of CTX group (P0.05). Conclusion: serum anti PLA2R antibody can be used as a specific marker of IMN, can be used in the diagnosis of disease, and is a potential diagnostic and therapeutic index. Both TAC and CTX have a certain therapeutic effect on IMN. After 6 months of treatment, the curative effect and remission rate of TAC were significantly better than those of CTX..
【學(xué)位授予單位】：新疆醫(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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