1、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(diǎn)實(shí)驗(yàn)室抗磷脂酶A2受體抗體與特發(fā)性膜性腎病秦衛(wèi)松研究背景研究方法結(jié)論研究背景研究背景研究背景V型狼瘡性腎炎：20例Glassock RJ.Detection of anti-PLA2R in idiopathic MNGlassock RJ.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，In those patients without anti-PLA2R:IgG4 deposition in glomeruli of tumor-MN.Low titer of anti-PLA2R in ne

2、gative idiopathic MNWhy remain 11 IMN patients negative?IgG4 in a glomerulus of a patient with tumor-MN but without circulating anti-PLA2R antibodies.PC: a MN serum that was positive under standard conditions diluted to 1:1000.經(jīng)抗病毒治療后患者尿蛋白部分緩解或完全緩解；免疫熒光以IgG、C3為主, C1q陰性；3 patients died of cancer;抗磷脂酶

3、A2受體抗體與特發(fā)性膜性腎病PC: a MN serum that was positive under standard conditions diluted to 1:1000.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。Beck Jr LH, et al. N Engl J Med ; 361: 11Western Blotting of Glomerular Proteins with Serumfrom Patients with IMN.V型狼瘡性腎炎：20例Beck Jr LH, et al. Glassock RJ. N Engl J Med, ,361:

4、 81Glassock RJ. N Engl J Med, 病例選擇特發(fā)性膜性腎?。?0例腎活檢時(shí)尿蛋白定量經(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(cè)陰性，無乙肝、丙肝感染、腫瘤病史，無重金屬、有機(jī)溶劑接觸史；特發(fā)性膜性腎病治療后緩解的病例：21例病例選擇特發(fā)性膜性腎?。?0例病例選擇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(shí)尿蛋白定量，尿沉渣紅細(xì)胞100萬/ml。乙肝相關(guān)膜性腎?。?/p>

5、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(duì)半檢測(cè)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(shí)尿蛋白定量。腫瘤相關(guān)膜性腎?。?0例腎活檢時(shí)尿蛋白定量病例選擇V型狼瘡性腎炎：20例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(shí)驗(yàn)方法從腎小球提取蛋白抗原SDS(Non-reduce研究結(jié)果研究結(jié)果 Detection of anti-PLA2R in idiopathic MN Detection of anti-PLA2R in

6、 idRecognition of idiopathic MN serum with deglycosylated PLA2RRecognition of idiopathic MN sThe prevalence of anti-PLA2R in idiopathic MN and secondary MNnAnti-PLA2R%Idiopathic MN604981.7%Lupus MN2015.0%HBV-MN1616.3%Tumor-MN10330%Table Anti-PLA2R in Chinese patients with membranous nephropathyThe p

7、revalence of anti-PLA2R i There was an absence of immunologic disease activity at the time when their serum was sampled, despite proteinuria.Why remain 11 IMN patients negative? There was an absence of imDetection of anti-PLA2R in idiopathic MNIgG4 in a glomerulus of a patient with tumor-MN but with

8、out circulating anti-PLA2R antibodies.PC: a MN serum that was positive under standard conditions diluted to 1:1000.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；persistent or relapse of proteinuria despite resection of the tumor.persistent or relapse of proteinuria despite resection of the tumor.Laure

9、nce H.腎活檢時(shí)尿蛋白定量，尿沉渣紅細(xì)胞100萬/ml。Anti-PLA2R in IMN and IMN with complete remission2 patients: complete remission of the proteinuria after tumor resection;PC: a MN serum that was positive under standard conditions diluted to 1:1000.V型狼瘡性腎炎：20例Low titer of anti-PLA2R in negative idiopathic MN特發(fā)性膜性腎病治療后緩解

10、的病例：21例Table Anti-PLA2R in Chinese patients with membranous nephropathyLow titer of anti-PLA2R in negative idiopathic MNLow titer of anti-PLA2R existed in 10 of remaining 11 negative IMN.PC: a MN serum that was positive under standard conditions diluted to 1:1000. HC, Healthy control, serum from hea

11、lthy adult (1:10). Detection of anti-PLA2R in idiAssociation of anti-PLA2R with disease activityAssociation of anti-PLA2R withAnti-PLA2R in IMN and IMN with complete remission81.7%19.0%Anti-PLA2R in IMN and IMN with結(jié) 論P(yáng)LA2R 是中國(guó)人特發(fā)性膜性腎病的重要靶抗原?？筆LA2R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。結(jié) 論P(yáng)LA2R 是中國(guó)人特發(fā)性膜性腎病的重要靶抗

12、原。致 謝劉志紅院士 David J. Salant Laurence H. Beck, Jr. 陳朝紅曾彩虹左科致 謝劉志紅院士IgG4 in a glomerulus of a patient with tumor-MN but without circulating anti-PLA2R antibodies. Bright IgG4 in a glomerulus of a patient with tumor-MN and circulating anti-PLA2R antibodies. IgG4 deposition in glomeruli of tumor-MN.IgG4 in a glomerulus of a patiAll three patients with Anti-PLA2R : persistent or relapse of proteinuria despite resection of the tumor. In those patients without anti-PLA2R:2 patients: complete remission of the proteinuria