Clinical application evaluation of PLA2R,THSD7A,and IgG4 in idiopathic membranous nephropathy
Objective To study and discuss the evaluation of clinical application of Phospholipase A2 receptor(PLA2R),thrombos-pondin type-1 domain-containing 7A(THSD7A)and IgG4 in idiopathic membranous nephropathy(IMN).Methods From June,2021 to August,2023,134 patients with glomerular disease were selected from Bazhou People's Hospital in Xinjiang as the research object.Ac-cording to the pathological diagnosis results of renal biopsy,the patients were divided into Idiopathic membranous nephropathy group and non-IMN group,and the expressions of serum PLA2R,renal tissue PLA2R,THSD7A and IgG4 were detected.The general data,serum PLA2R,serum THSD7A,,renal tissue PLA2R,renal tissue THSD7A,immunoglobulin and complement expression of the two groups were compared,Analyze the difference between positive and negative PLA2R antibodies in the IMN group,analyze their correla-tion,and draw ROC curves to explore their diagnostic value.Results In IMN patients,the age,serum PLA2R titer,positive rate of PLA2R in renal tissue,and fluorescence intensity of immunoglobulins IgG1,IgG4,and C3 in renal tissue were higher than those in non IMN groups;The 24-hour UP of the serum PLA2R positive group in IMN patients was significantly higher than that of the negative group,and the plasma albumin was lower than that of the negative group;Linear regression analysis showed a positive correlation be-tween serum PLA2R Ab and age of onset and changes in 24-hour UP(R=0.318,P=0.039,R=0.511,P=0.014);In the diagnosis of IMN,the specificity of serum PLA2R antibody,serum THSD7A antibody,renal tissue PLA2R,renal tissue THSD7A,and renal tissue IgG4 were 88.17%,63.49%,79.81%,63.07%,and 74.18%,respectively;The highest sensitivity was IgG4 in renal tissue(98.03%)and the area under the curve was the largest;Due to the low positive rate of THSD7A,there was no statistically significant difference between groups.Conclusion Serum PLA2R Ab,renal tissue PLA2R,renal tissue THSD7A,and renal tissue IgG4 have diagnostic and differen-tial diagnostic value for IMN.Patients with higher PLA2R antibody titers are relatively older and may be more prone to developing large amounts of proteinuria or hypoproteinemia.However,THSD7A,due to its lower positive rate,needs to be studied with a larger sample size in the future.
Idiopathic membranous nephropathyDiagnosisPhospholipase A2 receptorPlatelet reactive protein type 17A do-mainIgG4
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