抗磷脂酶A2受體抗體與特發(fā)性膜性腎病

抗磷脂酶A2受體抗體

與特發(fā)性膜性腎病秦衛(wèi)松南京軍區(qū)南京總醫(yī)院全軍腎臟病研究所全軍腎臟病重點實驗室精選課件研究背景研究方法結(jié)論精選課件研究背景精選課件BeckJrLH,etal.NEnglJMed2009;361:11WesternBlottingofGlomerularProteinswithSerumfromPatientswithIMN.精選課件GlassockRJ.NEnglJMed,2009,361:81精選課件病例選擇特發(fā)性膜性腎?。?0例腎活檢時尿蛋白定量>3.5g/24hr經(jīng)腎活檢病理明確診斷為腎小球膜性病變，光鏡觀察無內(nèi)皮或系膜細(xì)胞增殖，無內(nèi)皮下嗜復(fù)紅物沉積，免疫熒光以IgG、C3為主,C1q陰性；自身抗體檢測陰性，無乙肝、丙肝感染、腫瘤病史，無重金屬、有機溶劑接觸史；特發(fā)性膜性腎病治療后緩解的病例：21例精選課件病例選擇V型狼瘡性腎炎：20例系統(tǒng)性紅斑狼瘡、狼瘡性腎炎診斷明確；病理上以V型（膜性）病變?yōu)橹鳎庖邿晒庖灶w粒狀上皮側(cè)沉積為主，無明顯系膜或內(nèi)皮細(xì)胞增殖；腎活檢時尿蛋白定量>3.5g/24hr，尿沉渣紅細(xì)胞<100萬/ml。乙肝相關(guān)膜性腎病：16例經(jīng)腎活檢病理明確診斷為腎小球膜性病變；乙肝兩對半檢測顯示大三陽和/或HBV-DNA陽性；腎組織乙肝抗原染色陽性(其中HBeAg必須陽性)；經(jīng)抗病毒治療后患者尿蛋白部分緩解或完全緩解；腎活檢時尿蛋白定量>3.5g/24hr。腫瘤相關(guān)膜性腎?。?0例腎活檢時尿蛋白定量>3.5g/24hr精選課件從腎小球提取蛋白抗原SDS(Non-reduced)轉(zhuǎn)印至硝酸纖維素膜與患者血清孵育（1：25）一抗，二抗，顯色實驗方法精選課件研究結(jié)果精選課件Detectionofanti-PLA2RinidiopathicMN精選課件RecognitionofidiopathicMNserumwithdeglycosylatedPLA2R精選課件Theprevalenceofanti-PLA2RinidiopathicMNandsecondaryMNnAnti-PLA2R%IdiopathicMN604981.7%LupusMN2015.0%HBV-MN1616.3%Tumor-MN10330%TableAnti-PLA2RinChinesepatientswithmembranousnephropathy精選課件Therewasanabsenceofimmunologicdiseaseactivityatthetimewhentheirserumwassampled,despiteproteinuria.Whyremain11IMNpatientsnegative?精選課件Lowtiterofanti-PLA2RinnegativeidiopathicMNLowtiterofanti-PLA2Rexistedin10ofremaining11negativeIMN.PC:aMNserumthatwaspositiveunderstandardconditionsdilutedto1:1000.HC,Healthycontrol,serumfromhealthyadult(1:10).精選課件Associationofanti-PLA2Rwithdiseaseactivity精選課件Anti-PLA2RinIMNandIMNwithcompleteremission81.7%19.0%精選課件結(jié)論PLA2R是中國人特發(fā)性膜性腎病的重要靶抗原。抗PLA2R抗體可以作為特發(fā)性膜性腎病診斷和療效判斷的特異標(biāo)志物。精選課件致謝劉志紅院士DavidJ.SalantLaurenceH.Beck,Jr.

陳朝紅曾彩虹左科精選課件IgG4inaglomerulusofapatientwithtumor-MNbutwithoutcirculatinganti-PLA2Rantibodies.BrightIgG4inaglomerulusofapatientwithtumor-MNandcirculatinganti-PLA2Rantibodies.IgG4depositioninglomerulioftumor-MN.精選課件AllthreepatientswithAnti-PLA2R:persistentorrelapseofproteinuriadespiteresectionofthetumor.Inthosepatientswithoutanti-PLA2R:2patients:completeremissionoftheproteinuriaaftertumorresection;3patient