【摘要】 目的探讨的抗磷脂酶A2受体(PLA2R)和1型血小板反应蛋白7A域(THSD7A)在原发性膜性肾病(IMN)患者肾脏组织中的表达情况及对预后的影响。方法选取经肾脏组织病理活检确诊的190例膜性肾病(MN)患者,其中IMN 134例(IMN组),继发性膜性肾病(SMN)56例(SMN组)。再根据PLA2R和THSD7A的表达情况将IMN组患者分别分为PLA2R阳性组(102例)、PLA2R阴性组(32例)和THSD7A阳性组(20例)、THSD7A阴性组(114例)。收集所有患者的一般资料、临床资料[24h尿蛋白、白蛋白、总胆固醇(TC)、甘油三酯(TG)、估算的肾小球滤过率(eGFR)、病理分期]、PLA2R和THSD7A的表达情况及IMN患者接受免疫治疗情况、治疗结果和预后并分组进行比较。结果 IMN组患者PLA2R和THSD7A的阳性率均高于SMN组(P <0.01)。PLA2R阳性组男性比例、eGFR、病理分期Ⅱ和Ⅲ期患者比例均高于PLA2R阴性组(P <0.001)。THSD7A阳性组eGFR、病理分期Ⅰ和Ⅲ期患者比例均高于THSD7A阴性组(P <0.001)。PLA2R阴性组治疗后12个月完全缓解患者比例显著高于PLA2R阳性组,12个月部分缓解患者比例显著低于PLA2R阴性组(P <0.05)。PLA2R阳性组患者中位完全缓解时间低于PLA2R阴性组(P=0.007)。结论 PLA2R、THSD7A在IMN中阳性率高且PLA2R的阳性表达影响患者的中位完全缓解时间。更多还原

【Abstract】 Objective To explore the expression of anti-phospholipase A2 receptor( PLA2R) and type 1 thrombospondin 7 A domain( THSD7A) in renal tissues of primary membranous nephropathy( IMN) patients and its influence on the prognosis of patients. Methods A total of 190 patients with membranous nephropathy( MN) diagnosed by pathological biopsy of the kidney were selected,including134 cases of IMN( IMN group) and 56 cases of secondary membranous nephropathy( SMN,SMN group).According to the expression of PLA2R and THSD7A,patients in the IMN group were divided into PLA2R positive group( 102 cases),PLA2R negative group( 32 cases),THSD7A positive group( 20 cases),and THSD7A negative group( 114 cases). General and clinical data of all patients[24 h urine protein,albumin,total cholesterol( TC),triglycerides( TG),estimated glomerular filtration rate( eGFR),pathological stage],PLA2R and THSD7A expression and IMN patients receive immunotherapy status,treatment results and prognosis were collected and compared in groups. Results The positive rates of PLA2R and THSD7A in the IMN group were higher than those in the SMN group( P < 0. 01). The proportion of males in the PLA2R-positive group,eGFR,proportion of patients pathological with stage Ⅱ and Ⅲ were higher than those in the PLA2R-negative group( P < 0. 001). The eGFR,proportion of patients with pathological stageⅠ and Ⅲ in the THSD7A positive group were higher than those in the THSD7A negative group( P < 0. 001). The proportion of patients with complete response 12 mouths after treatment in the PLA2R negative group was significantly higher than that in the PLA2R positive group,and the propartion of patients with partial response 12 months after treatment was sighificantly lower than that in the PLA2R positive group( P < 0. 05). The median complete remission time of patients in the PLA2R positive group was lower than that in the PLA2R negative group( P = 0. 007). Conclusion The positive expression rate of PLA2R and THSD7A in IMN is high and the positive expression of PLA2R affects the patient’s median complete remission time.更多还原