内科

目的探讨血清抗磷脂酶A2受体（PLA2R）抗体在特发性膜性肾病（IMN）诊断和治疗效果评价中的价值。方法选取2017年1月至2018年12月在我院经肾穿刺活检确诊的IMN患者114例作为IMN组，选取同期我院收治的非IMN肾病患者68例作为非IMN组。采用改良意大利方案对IMN组患者进行治疗，根据慢性肾脏疾病指南对非IMN组患者进行治疗。比较两组患者的血清抗PLA2R抗体阳性率；以肾穿刺活检结果作为诊断IMN的金标准，分析根据血清抗PLA2R抗体水平诊断IMN的灵敏度和特异度，评价两者诊断的一致性；根据治疗效果将IMN患者分为完全缓解组、部分缓解组、未缓解组，比较三组患者治疗前后的抗PLA2R抗体水平。结果IMN组与非IMN组患者的抗PLA2R抗体阳性率分别为87.72%（100/114）和5.88%（4/68），两组比较差异有统计学意义（P＜0.05）。以肾穿刺活检结果作为诊断IMN的金标准，根据血清抗PLA2R抗体水平诊断IMN的灵敏度为87.72%，特异度为94.12%,两者诊断的一致性检验Kappa值为0.856（P＜0.05）。治疗6个月后，IMN组患者中完全缓解组和部分缓解组患者的血清抗PLA2R抗体滴度均显著降低，表现为完全缓解组＜部分缓解组＜未缓解组，差异有统计学意义（P＜0.05）。结论血清抗PLA2R抗体可作为诊断IMN的特异性血清生物学标志物，其水平与患者的治疗效果关系密切，可作为判断患者治疗效果或转归的一个重要指标。

ObjectiveTo investigate the value of serum anti-phospholipase A2 receptor (PLA2R) antibody in the diagnosis and efficacy evaluation of idiopathic membranous nephropathy (IMN). MethodsA total of 114 patients with IMN confirmed by renal biopsy in our hospital from January 2017 to December 2018 were selected as IMN group, and 68 patients with non-IMN kidney disease admitted to our hospital during the same period were selected as non-IMN group. Patients in the IMN group were treated with a modified Italian scheme, and patients in the non-IMN group were treated according to guidelines for chronic kidney disease. The positive rate of serum anti-PLA2R antibody was compared between the two groups. The sensitivity and specificity of serum anti-PLA2R antibody level in the diagnosis of IMN were analyzed to evaluate the diagnosis consistency using renal biopsy result as the gold standard for the diagnosis of IMN; according to the therapeutic effect, IMN patients were divided into complete remission group, partial remission group, and non-remission group. The levels of anti-PLA2R antibody in the three groups before and after treatment were compared. ResultsThe positive rate of anti-PLA2R antibody in the IMN group and non-IMN group were 87.72% (100/114) and 5.88% (4/68), respectively, and the difference was statistically significant (P＜0.05). Using renal biopsy results as the gold standard for diagnosis of IMN, the sensitivity of serum anti-PLA2R antibody level to diagnose IMN was 87.72%, and the specificity was 94.12%. The diagnostic consistency of Kappa was 0.865. After 6 months of treatment, the serum PLA2R antibody titer in the complete remission group and partial remission group decreased significantly, which indicated a ascending order in the complete remission group, partial remission group and non-remission group, with statistically significant difference (P＜0.05). ConclusionSerum anti-PLA2R antibody can be used as a specific serum biological marker for diagnosing IMN, which is closely related to the therapeutic effect of the patients. It can be used as an important indicator to estimate the therapeutic effect or outcome of IMN.