目的：检测不同类型膜性肾病(membranous nephropathy，MN)患者肾组织PLA2R、Nephrin及血 清anti-PLA2R的表达量，判断它们之间是否存在相关性及其意义。方法：收集MN患者37例为实 验组，包括特发性膜性肾病(idiopathic membranous nephropathy，IMN)患者23例、HBV相关性 MN(HBV-MN)患者8例、V型狼疮性肾炎(stage V lupus nephritis，LN-V)患者6例，选取10例肾肿瘤 行一侧肾切术患者为对照组。应用免疫组织化学法检测各组肾组织中PLA2R及Nephrin的表达，通 过专业图像处理软件对其表达进行半定量分析，并应用ELISA检测各组血清anti-PLA2R的表达量。 结果：1)各实验组及对照组均可见PLA2R及Nephrin沿肾小球毛细血管袢沉积。IMN组PLA2R较其 余各组表达量明显升高，差异有统计学意义，而剩余三组比较无统计学差异。各组Nephrin相对表 达量，对照组>LN-V>HBV-MN>IMN，差异有统计学意义；2)IMN组肾组织Nephrin相对表达量同 肾组织PLA2R及血清anti-PLA2R浓度间均负相关，肾组织PLA2R相对表达量同血清anti-PLA2R浓度 呈正相关；3)IMN组中血清anti-PLA2R阳性者其肾组织PLA2R均表达升高。结论：IMN患者肾组织 中PLA2R的表达较继发性膜性肾病(secondary membranous nephropathy，SMN)及正常对照组高， IMN组中血清anti-PLA2R阳性者其肾组织PLA2R均表达升高，临床上可联合二者共同鉴别MN是否 原发，结合肾组织中Nephrin的检测，可增强其敏感性。PLA2R同足细胞裂孔隔膜蛋白Nephrin于 IMN患者肾组织表达量呈负相关，为IMN的发病机制的研究提供进一步支持。
The expression of PLA2R, anti-PLA2R and Nephrin in different types of membranous nephropathy
Objective: To detect the expression of M-type phospholipase A2 receptor (PLA2R), Nephrin and serum anti- PLA2R in different types of membranous nephropathy (MN), and further to investigate whether there is a correlation between them and the significance. Methods: Thirty-seven patients diagnosed as MN, including 23 patients with idiopathic membranous nephropathy (IMN), 8 patients with HBV-MN and 6 cases with stage V lupus nephritis (LN-V) were collected in this study as experimental group. Ten renal carcinoma patients treated by unilateral nephrectomy were regarded as control group. The expressions of PLA2R and Nephrin in the kidney tissues of these patients were detected by immunohistochemical and semi-quantitated by image analysis system. Enzyme-linked immuno-absorbentassay (ELISA) methods were applied in the detection of serum anti-PLA2R concentration. Results: 1)PLA2R and Nephrin can be seen staining along the glomerular capillary loops both in the experimental group and control group. Compared with the IMN group, PLA2R expression quantity was significantly lower in the rest of the three groups. And there were no statistical difference between the rests of the three groups. Nephrin relative expression quantity in different groups: control group>LN-V> HBV-MN>IMN, the difference were statistically significant; 2) In the IMN group, Nephrin relative expression quantity showed a negative correlation relationship with both the expression of PLA2R in renal biopsy tissue and serum anti- PLA2R concentration. PLA2R relative expression quantity had a positive correlation relationship with serum anti- PLA2R concentration; 3) All the patients who express positive anti-PLA2R in the IMN group had an enhanced expression of PLA2R in kidney tissue. Conclusion: People can combine the enhanced expression of PLA2R in renal tissue with the serum anti-PLA2R’ positive expression to distinguish IMN from SMN. To combine them with the expression of Nephrin can improve its sensitivity. Nephrin expression quantity had a negative correlation relationship with that of PLA2R in IMN patients, which provide further support to the research of the pathogenesis of IMN.