Clinical value of joint detection of serum PLA2R antibody, KIM-1 and Hcy in diagnosis of patients with idiopathic membranous nephropathy
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摘要: 目的 探究血清抗磷脂酶A2受体(PLA2R)抗体、肾损伤分子-1(KIM-1)和同型半胱氨酸(Hcy)联合检测在特发性膜性肾病(IMN)患者诊断中的临床价值。方法 选取2014年3月至2021年3月行肾穿刺活检确诊为IMN的患者150例，并选取同一时期的健康体检者100例作为对照组。将IMN患者按照病理分期分为Ⅰ期51例、Ⅰ~Ⅱ期49例和Ⅱ期50例，并比较各组血清PLA2R抗体、KIM-1和Hcy水平的差异，进一步用ROC曲线图分析血清PLA2R抗体、KIM-1和Hcy水平以及3项指标联合在IMN患者诊断中的临床价值。结果 Ⅰ期组、Ⅰ~Ⅱ期组、Ⅱ期组的血清PLA2R抗体、KIM-1和Hcy水平高于对照组，差异有统计学意义(P< 0.05)，且Ⅱ期组水平高于Ⅰ期组、Ⅰ~Ⅱ期组，Ⅰ~Ⅱ期组水平高于Ⅰ期组，差异有统计学意义(P< 0.05)。ROC曲线图显示，血清PLA2R抗体、KIM-1和Hcy水平以及3项指标联合诊断IMN患者的曲线下面积(AUC)分别为0.648、0.921、0.781、0.989，联合检测诊断模式的诊断效能均比单一指标模式有明显提高。结论 血清PLA2R抗体、KIM-1和Hcy是诊断IMN的较好指标，3项指标联合诊断对IMN患者具有更重要的诊断价值。Abstract: Objective To explore the clinical value of joint detection of serum anti-phospholipase A2 receptor(PLA2R) antibody, kidney injury molecule-1(KIM-1) and homocysteine(Hcy) in the diagnosis of patients with idiopathic membranous nephropathy(IMN).Methods A total of 150 patients with IMN diagnosed by renal biopsy in the hospital were enrolled in this study between March 2014 and March 2021. Meanwhile, 100 healthy individuals were selected as the control group. Patients with IMN were divided into stage Ⅰ group(51 cases), stage Ⅰ-Ⅱ group(49 cases) and stage Ⅱ group(50 cases) according to the pathological stage. The levels of serum PLA2R antibody, KIM-1 and Hcy were compared between the groups. The ROC curve was used to analyze the clinical value of serum PLA2R antibody, KIM-1, Hcy, and joint detection of the three in the diagnosis of patients with IMN.Results The levels of serum PLA2R antibody, KIM-1 and Hcy in patients with IMN were higher than those in the control group(P< 0.05), and the levels increased with the increase of pathological stage(P< 0.05). The ROC curve analysis showed that the area under the curve(AUC) values of serum PLA2R antibody, KIM-1, Hcy, and combination of the three to diagnose IMN were 0.648, 0.921, 0.781 and 0.989, respectively. The efficiency of combined diagnosis was significantly higher than single index diagnosis.Conclusion Serum PLA2R antibody, KIM-1 and Hcy may be important indicators for diagnosing IMN. The joint detection of the three indicators can achieve better diagnostic performance.
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表 1 各组一般资料对比
X ±S 组别 例数 性别/例 年龄/岁 病程/月 收缩压/mmHg 舒张压/mmHg 体重指数/(kg·m-2) 男 女 Ⅰ期组 51 26 25 48.87±5.36 2.26±0.22 123.21±10.23 82.36±6.12 25.12±2.14 Ⅰ~Ⅱ期组 49 26 23 49.12±6.12 2.29±0.23 122.98±10.19 82.58±6.23 24.88±2.82 Ⅱ期组 50 24 26 50.07±7.03 2.32±0.24 123.41±9.87 81.98±7.12 25.32±2.01 对照组 100 55 45 49.37±6.38 - 122.87±11.01 82.25±6.34 24.99±2.64 F/χ2 - 0.709 0.341 0.859 0.034 0.075 0.309 P - 0.871 0.796 0.426 0.992 0.973 0.819 
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表 2 各组受检者血清指标水平比较
X ±S 组别 例数 PLA2R/(U·mL-1) KIM-1/(μg·mL-1) Hcy/(μmol·L-1) Ⅰ期组 51 95.88±4.121) 1.53±0.221) 13.88±3.251) Ⅰ~Ⅱ期组 49 130.78±3.391)2) 2.12±0.641)2) 17.52±3.971)2) Ⅱ期组 50 238.32±3.261)2)3) 3.54±0.251)2)3) 19.34±4.121)2)3) 对照组 100 45.23±2.58 1.13±0.11 10.12±2.35 F - 40487.669 632.203 108.718 P - < 0.001 < 0.001 < 0.001 与对照组比较，1)P < 0.05；与Ⅰ期组比较，2)P < 0.05；与Ⅰ~Ⅱ期组比较，3)P < 0.05。
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表 3 血清PLA2R抗体、KIM-1和Hcy以及3项指标联合在IMN中的诊断价值分析
指标 曲线下面积 截断值 标准误差 灵敏度/% 特异度/% 95% CI P PLA2R 0.648 52.825 0.042 84.00 75.00 0.585~0.707 < 0.001 KIM-1 0.921 1.313 0.013 81.33 99.00 0.890~0.945 < 0.001 Hcy 0.781 12.881 0.024 64.00 81.00 0.738~0.821 < 0.001 PLA2R+KIM-1+Hcy 0.989 0.747 0.003 95.33 97.00 0.974~0.997 < 0.001
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