背景:M型磷脂酶A2受体(PLA2R)是成人特发性膜性肾病(IMN)的主要自身抗原。尽管已经鉴定了PLA2R结构域中的反应性表位,抗PLA2R抗体识别的这些结构域的临床价值仍存在争议.因此,这项研究旨在定量检测IMN患者治疗前后针对PLA2R表位的不同抗体浓度的变化,以评估表位扩散的临床价值。
方法:高灵敏的时间分辨荧光免疫分析法用于定量分析针对PLA2R及其表位的特异性IgG和IgG4抗体的浓度(CysR,CTLD1,CTLD6-7-8)在25例PLA2R相关膜性肾病患者的队列中(缓解和非缓解组中的13例和12例,分别)治疗前后,并结合临床生化指标对结果进行分析。
结果:针对PLA2R及其表位的特异性IgG(IgG4)抗体的浓度(CysR,未缓解组的CTLD1和CTLD6-7-8)高于缓解组。IgG(IgG4)抗体升高倍数为5.6(6.2)倍,3.0(24.3)折1.6(9.0)折,在非缓解/缓解组中为4.2(2.6)倍,分别。然而,随访结束时,两组之间的抗体浓度差异为5.6(85.2),1.7(13.1),1.0(5.1)、高出1.5(22.3)倍,分别。当检测针对PLA2R及其不同表位的特异性IgG抗体的浓度时,M0处仅一个表位的缓解率为66.67%,M0处为三个表位的缓解率为36.36%。当检测针对PLA2R及其不同表位的特异性IgG4抗体的浓度时,M0处仅一个表位的缓解率为100.00%,M0处为三个表位的缓解率为50.00%。eGFR联合检测的三变量逻辑回归模型,抗CTLD678IgG4和尿蛋白的AUC为100.00%。
结论:最初诊断时低浓度的抗CysR-IgG4、抗CTLD1-IgG4和抗CTLD6-7-8-IgG4预测治疗后快速缓解。使用针对PLA2R及其不同表位的特异性IgG4结合eGFR和尿蛋白可更好地评估IMN的预后结果。
BACKGROUND: M-type phospholipase A2 receptor (PLA2R) is the major autoantigen in adult idiopathic membranous nephropathy (IMN). Although reactive epitopes in the PLA2R domains have been identified, the clinical value of these domains recognized by anti-PLA2R antibodies remains controversial. Accordingly, this study aimed to quantitatively detect changes in the concentrations of different antibodies against epitopes of PLA2R in patients with IMN before and after treatment to evaluate the clinical value of epitope spreading.
METHODS: Highly sensitive time-resolved fluorescence immunoassay was used to quantitatively analyze the concentrations of specific IgG and IgG4 antibodies against PLA2R and its epitopes (CysR, CTLD1, CTLD6-7-8) in a cohort of 25 patients with PLA2R-associated membranous nephropathy (13 and 12 in the remission and non-remission groups, respectively) before and after treatment, and the results were analyzed in conjunction with clinical biochemical indicators.
RESULTS: The concentration of specific IgG (IgG4) antibodies against PLA2R and its epitopes (CysR, CTLD1 and CTLD6-7-8) in non-remission group was higher than that in remission group. The multipliers of elevation of IgG (IgG4) antibody were 5.6(6.2) fold, 3.0(24.3) fold, 1.6(9.0) fold, and 4.2(2.6) fold in the non-remission/remission group, respectively. However, the difference in antibody concentrations between the two groups at the end of follow-up was 5.6 (85.2), 1.7 (13.1), 1.0 (5.1), and 1.5 (22.3) times higher, respectively. When detecting concentrations of specific IgG antibodies against PLA2R and its different epitopes, the remission rate was 66.67% for only one epitope at M0 and 36.36% for three epitopes at M0. When detecting concentrations of specific IgG4 antibodies against PLA2R and its different epitopes, the remission rate was 100.00% for only one epitope at M0 and 50.00% for three epitopes at M0. A trivariate logistic regression model for the combined detection of eGFR, anti-CTLD678 IgG4, and urinary protein had an AUC of 100.00%.
CONCLUSIONS: Low concentrations of anti-CysR-IgG4, anti-CTLD1-IgG4, and anti-CTLD6-7-8-IgG4 at initial diagnosis predict rapid remission after treatment. The use of specific IgG4 against PLA2R and its different epitopes combined with eGFR and urinary protein provides a better assessment of the prognostic outcome of IMN.