·198··临床研究·血清抗PLA2R抗体和肾小球IgG4联合检测在膜性肾病诊断中的应用管音李航段琳李艳文煜冰李学旺【摘要】目的探讨膜性肾病(MN)患者血清抗磷脂酶A2受体(PLA2R)抗体与肾小球IgG4的相关性，评价血清抗PLA2R抗体和肾小球IgG亚型检测在膜性肾病诊断中的价值。方法病例来自2011年10月至2014年4月北京协和医院收治的MN患者，按照临床诊断分为特发性膜性肾病(IMN)组，膜型狼疮肾炎组(MLN)和继发性膜性肾病(SMN)组。间接免疫荧光法检测患者血清抗PLA2R抗体水平。免疫荧光法检测患者肾小球IgG亚型表达。采用受试者工作特征(ROC)曲线分析血清抗PLA2R抗体和肾小球IgG4的诊断价值。结果IMN组血清抗PLA2R抗体阳性率69．5％(41／59)；MLN组阳性率4．8％(1／21)。IMN组中血清抗PLA2R抗体和肾小球IgG4共阳性者35例，血清抗PLA2R抗体阳性而肾小球IgG4阴性者6例，血清抗PLA2R抗体阴性而。肾小球IgG4阳性者17例，血清抗PLA2R抗体和。肾小球IgG4共阴性者1例。血清抗PLA2R抗体诊断IMN的灵敏度69．5％，特异度95．2％；肾小球IgG4亚型诊断IMN的灵敏度89．8％，特异度52．3％；两者共阳性的灵敏度59．3％，特异度100．0％。6例乙型肝炎病毒(HBV)相关性膜性肾病患者中4例血清抗PLA2R抗体阳性，3例干燥综合征(pSS)相关性膜性肾病和3例肿瘤相关性膜性肾病患者各有1例血清抗PLA2R抗体呈阳性。结论IMN患者血清抗PLA2R抗体阳性率高，SMN患者PLA2R抗体阳性率随病因而异；血清抗PLA2R抗体联合肾小球IgG4亚型检测有助于膜性肾病病因的诊断和鉴别诊断。【关键词】肾病，膜性；IgG4；抗磷脂酶A2受体抗体Serumanti-phospoHpaseA2receptorantibodiesandglomerularIgG4inthediagnosisofmembranousnephropathyGuanYin,LiHang,DuanLin,LiYan,WenYubing,LiXuewang．DepartmentofNephrology,PekingUnionMedicalCollegeHospital,Beqing100730,ChinaCorrespongdingauthor：LiHang,Emaihlihang@hotmail．con【Abstract】0bjeetiveTodiscusstherelationshipbetweenserumanti-PhosphalipaseA2receptor妒LA2R)antibodiesandglomemlarIgG4subclassinpatientswithmembranousnephropathyandevaluatethediagnosticvalueofthetwomarkers．MethodsPatientsdiagnosedasmembranousnephropathyfromOctober2011toApril2014inPekingUnionMedicalCollegeHospitalwereincludedanddividedintoIMNandSMNgroupsaccedingtotheirclinicaldiagnosis．Serumanti—PLA2Rantibodiesand甜omendarIgGsubclasseswerebothdetectedbyindirectimmunofluorescenceassay．Receiveroperatorcharacteristiccurveswereusedtoevaluatethediagnosticefficiencyofanti—PLA2RantibodiesandglomerularIgG4．ResultsPrevalenceofserumanti-PLA2RantibodiesofIMNpatientswas69．5％(41／59)；prevalenceofMLNpatientswas4．8％(1／21)．WithintheIMNgroup，thirty-fivepatientsshowedpositiveresultsofbothserumanti—PLA2RantibodiesandglomemlarIgG4；SixpatientswerepositiveforseiMmanti-PLA2RantibodiesbutnegativefordomemlarIgG4；SeventeenpatientswerepositiveforglomemlarIgG4butnegativeforserumanti—PLA2Rantibodies；onepatientDOI：10．3760／cma．j．issn．1001—7097．2015．03．008基金项目：国家科技支撑计划(2011BAll0803)作者单位：100730北京，中国医学科学院北京协和医学院肾内科通信作者：李航，Email：lihang@hotmail．corn万方数据wasnegativeforbothtests．Thesensitivityofserumanti-PLA2Rantibodywas69．5％andthespecificitywas95．2％：thesensitivityofglomerularIs04was89．8％andthespecificitywas52．3％．Thesensitivityofthecombinedmarkerconsistingofserumanti—PLA2RantibodyandglomerularIgG4was59．3％andthespecificitywas100％．FouroutofthesixpatientssecondarytoHBVinfection．oneoutofthethreepatientssecondarytoSjfigrensyndrome，oneoutofthethreepatientssecondarytomalignanttumorshowedpositiveresultsofSel'umanti—PLA2Rantibodies．ConclusionsSerumanti-PLA2RantibodieswereofhighprevalenceamongI...
