背景:国际惯例指南提倡使用抗磷脂酶A2受体(PLA2R)抗体检测来诊断原发性膜性肾病(pMN)。本研究旨在阐明日本pMN诊断中抗PLA2R抗体测试的现状,并审查与实施该抗体测试相关的因素。
方法:利用基于网络的肾病学家问卷,在2021年11月至2021年12月期间,从306家机构和427名肾脏病学家收集了回复。还研究了抗PLA2R抗体测试的偏好。与定量抗PLA2R抗体的经验有关的因素是通过广义估计方程,使用对隶属关系的设施簇进行方差的稳健分析来估计的。
结果:在427名受访者中,140人(32.8%)在他们目前的工作场所有以前的测量经验,165人(38.6%)总体上有以前的测量经验。在没有肾活检禁忌症的pMN疑似病例中,147名(34.4%)受访者选择请求抗PLA2R抗体检测。在大学医院中,受访者在当前工作地点进行抗PLA2R抗体定量的经验通常较高,并且随着肾脏活检的年度数量和毕业后的年数而增加。
结论:这项研究的结果表明,日本有很大一部分肾病学家没有进行抗PLA2R抗体测定的经验,并且分析可能会受到当前工作场所能力有限以及设施和患者的经济负担的阻碍。
BACKGROUND: International practice
guidelines advocate for the use of anti-phospholipase A2 receptor (PLA2R) antibody testing to diagnose primary membranous nephropathy (pMN). This study aimed to clarify the current status of anti-PLA2R antibody testing in the diagnosis of pMN in Japan and to scrutinize the factors associated with the implementation of this antibody test.
METHODS: Utilizing a web-based questionnaire for nephrologists, responses were collected from 306 facilities and 427 nephrologists between November 2021 and December 2021. Preference for anti-PLA2R antibody testing was also investigated. Factors related to the experience of quantifying anti-PLA2R antibodies were estimated by generalized estimating equations using a robust analysis of variance with clusters of facilities of affiliation.
RESULTS: Of the 427 respondents, 140 (32.8%) had previous measurement experience at their current workplace and 165 (38.6%) had previous measurement experience overall. In pMN-suspected cases without contraindications to renal biopsy, 147 (34.4%) of the respondents opted to request anti-PLA2R antibody testing. The respondents\' experience with anti-PLA2R antibody quantification at their current place of work was generally higher in university hospitals and increased with the annual number of kidney biopsies and the number of years since graduation.
CONCLUSIONS: The results of this study suggest that a significant proportion of nephrologists in Japan have no experience in performing anti-PLA2R antibody assays, and that the assays may be hampered by the limited capabilities of the current workplace and the financial burden on facilities and patients.