血清 MBL, BAFF 与磷脂酶 A2 受体相关特发性 膜性肾病患者肾功能及疗效的关系.

Objective To investigate the relationships between serum mannan-binding lectin (MBL), B-cell activating factor of the tumor necrosis factor family (BAFF) and renal function and outcome of patients with phospholipase A2 receptor (PLA2R) -related idiopathic membranous nephropathy (IMN) . Methods Totally 103 patients with PLA2R-related IMN were selected as the observation group, and the patients with PLA2R-related IMN were divided into the non-remission group (n=44) and the remission group (n=59) according to the therapeutic efficacy； and another 67 cases of healthy physical examination volunteers were selected as the control group during the same period. Relevant data were collected； serum MBL, BAFF, and 24 h urine protein were detected by ELISA, blood creatinine was detected by PA rate microplate assay kit, and the estimated glomerular filtration rate (eGFR) was calculated. Spearman correlation method was used to analyze the correlation between serum MBL and BAFF levels and renal function indexes in patients with PLA2R-related IMN； multifactorial Logistic regression was used to analyze the factors affecting the efficacy of patients with PLA2R-related IMN, and the receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum MBL and BAFF for the unremitted treatment in patients with PLA2R-related IMN. Results Serum MBL, BAFF levels and 24 hurine protein were higher in the observation group than in the control group, and eGFR was lower than that in the control group (all P<0. 05) . Serum MBL and BAFF levels in patients with PLA2R-related IMN were negatively correlated with eGFR (r=-0. 777, -0. 760, respectively； all P<0. 05) and were positively correlated with 24 h urinary protein (r=0. 883, 0. 828, respectively； all P<0. 05) . Albumin and eGFR were lower in the non-remission group than in the remission group, and 24 h urinary protein, MBL and BAFF were higher than those in the remission group (all P<0. 05) . There were no statistically significant differences in the gender, age, blood creatinine, blood uric acid, blood urea nitrogen, total cholesterol, triglycerides, IgG, complement 3 or PLA2R antibody titer between the two groups (all P＞0. 05) . Elevated albumin and eGFR were independent protective factors affecting the outcome of patients with PLA2R-related IMN (all P<0. 05), and elevated 24-hour urinary protein, MBL, and BAFF were independent risk factors (all P<0. 05) . The area under the curve of serum MBL and BAFF in prediction of unremitted treatment in patients with PLA2R-related IMN (0. 880) was greater than that of either alone (0. 791, 0. 787), with statistically significant difference (Z=2. 694, 2. 613 respectively； both P<0. 05) . Conclusion Elevated serum MBL and BAFF levels are associated with reduced renal function and poor outcome in patients with PLA2R-related IMN, the combined detection of the two has a higher value in predicting the unrelieved treatment of PLA2R-related IMN patients. [ABSTRACT FROM AUTHOR]