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(diǎn)實(shí)驗(yàn)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(shí)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(wú)內(nèi)皮或系膜細(xì)胞增殖，無(wú)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(wú)乙肝、丙肝感染、腫瘤病史，無(wú)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?，免疫熒光以顆粒狀上皮側(cè)沉積為主，無(wú)明顯系膜或內(nèi)皮細(xì)胞增殖；腎活檢時(shí)尿蛋白定量>3.5g/24hr，尿沉渣紅細(xì)胞<100萬(wàn)/ml。乙肝相關(guān)膜性腎?。?6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(yáng)和/或HBV-DNA陽(yáng)性；腎組織乙肝抗原染色陽(yáng)性(其中HBeAg必須陽(yáng)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>3.5g/24hr。腫瘤相關(guān)膜性腎?。?0例腎活檢時(shí)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(shí)驗(yàn)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。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