2021 年第 8 期 第 16 卷

肾组织M型磷脂酶A2受体免疫组织化学染色结果的研究

The Results of M-type phospholipase A2 receptor immunohistochemical staining in renal tissue

作者：孙丽君1程虹1董鸿瑞1王国勤1王艳艳1程文荣1叶楠1徐潇漪1赵智睿1赵晓毅2耿燕秋3

英文作者：Sun Lijun1 Cheng Hong1 Dong Hongrui1 Wang Guoqin1 Wang Yanyan1 Cheng Wenrong1 Ye Nan1 Xu Xiaoyi1 Zhao Zhirui1 Zhao Xiaoyi2 Geng Yanqiu3

单位：1首都医科大学附属北京安贞医院肾内科100029；2赤峰学院附属医院肾内科024005；3中国人民解放军总医院第三医学中心肾脏病科，北京100039

英文单位：1Department of Nephrology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Nephrology Affiliated Hospital of Chifeng University Chifeng 024005 China; 3Department of Nephrology the Third Medical Center Chinese PLA General Hospital Beijing 100039 China

关键词：膜性肾病；免疫组织化学染色；M型磷脂酶A2受体

英文关键词：Membranousnephropathy;Immunohistochemicalstaining; M-typephospholipaseA2receptor

• 摘要：

• 目的 探讨肾组织M型磷脂酶A2受体（PLA2R）免疫组织化学染色阳性的标准。方法 回顾性分析2010年1月至2020年12月首都医科大学附属北京安贞医院诊断为特发性膜性肾病（IMN）583例患者的临床资料。根据肾组织PLA2R免疫组织化学染色结果将患者分为PLA2R阳性组、PLA2R可疑阳性组和PLA2R阴性组。收集3组临床资料及免疫球蛋白G（IgG）亚类分布情况。比较PLA2R可疑阳性组和PLA2R阴性组1型血小板反应蛋白7A域（THSD7A）和神经表皮生长因子样1蛋白（NELL-1）免疫组织化学染色情况。结果 肾组织PLA2R免疫组织化学染色结果显示，PLA2R阳性组患者548例、PLA2R可疑阳性组14例、PLA2R阴性组21例。PLA2R阳性组低倍镜可见PLA2R阳性沉积在肾小球，强阳性，呈深红色；高倍镜见上皮下沉积、沿毛细血管壁分布；油镜下形态为点-线样、粗或细的颗粒状。3组患者性别、年龄、尿蛋白定量、血清白蛋白、血肌酐水平及肾病综合征比例差异均无统计学意义（均P＞0.05）。PLA2R阳性组血清抗PLA2R抗体阳性比例高于PLA2R阴性组、PLA2R可疑阳性组，IgG4阳性率、IgG4阳性为主比例均高于PLA2R阴性组、PLA2R可疑阳性组，差异均有统计学意义（均P＜0.05）。PLA2R阴性组与PLA2R可疑阳性组上述指标差异均无统计学意义（均P＞0.05）。PLA2R可疑阳性组THSD7A阳性、NELL-1阳性、THSD7A和NELL-1均阴性比例与PLA2R阴性组比较［14.3%（2/14）比14.3%（3/21）、57.1%（8/14）比28.6%（6/21）、28.6%（4/14）比57.1%（12/21）］，差异均无统计学意义（均P＞0.05）。结论 PLA2R可疑阳性与PLA2R阴性IMN患者临床及相关病理资料结果表现较为一致，因此PLA2R可疑阳性的沉积形态应该判读为PLA2R阴性。PLA2R阳性标准为PLA2R在肾小球上皮下沿毛细血管壁呈点-线样、粗或细的颗粒状沉积。

• Objective To investigate the criteria for judging the positive M-type phospholipase A2 receptor(PLA2R) immunohistochemical staining in renal tissue. Methods From January 2010 to December 2020, clinical data of 583 patients with idiopathic membranous nephropathy (IMN) admitted to Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed. According to the Results of PLA2R immunohistochemical staining in renal tissue, patients were divided into PLA2R positive group, PLA2R suspiciously positive group and PLA2R negative group. Clinical data and distribution of immunoglobulin G (IgG) subclasses of the three groups were recorded. The Results of type-1 domain-containing 7A (THSD7A) and neural epidermal growth factor-like 1 protein (NELL-1) immunohistochemical staining were compared between PLA2R suspiciously positive group and PLA2R negative group. Results PLA2R immunohistochemical staining showed that there were 548 patients in PLA2R positive group, 14 patients in PLA2R suspiciously positive group and 21 patients in PLA2R negative group. PLA2R deposition was strongly positive and deepred in the glomerulus at low magnification. The deposition was located in subepithelial area and distributed along the capillary wall at high magnification. The pattern of deposition was dot-line like, coarse or fine granules under the oil lens. There were no significant differences in gender, age, urinary protein quantification, serum albumin, serum creatinine levels and nephrotic syndrome ratio among the three groups(all P>0.05). The rate of positive anti-PLA2R antibody in PLA2R positive group was higher than that in PLA2R suspiciously positive group and PLA2R negative group, and rates of IgG4 positive and IgG4 positive domination in PLA2R positive group were higher than those in PLA2R suspiciously positive group and PLA2R negative group(all P<0.05). There were no significant differences in above indexes between PLA2R suspiciously positive group and PLA2R negative group(all P>0.05). There were no significant differences in rates of THSD7A positive, NELL-1 positive and THSD7A and NELL-1 negative between PLA2R suspiciously positive group and PLA2R negative group ［14.3%（2/14） vs 14.3%（3/21）, 57.1%（8/14） vs 28.6%（6/21）, 28.6%（4/14） vs 57.1%（12/21）］(all P>0.05). Conclusion s The clinical and pathological data of the IMN patients with PLA2R suspiciously positive and PLA2R negative are consistent. The deposition morphology of PLA2R suspiciously positive in renal tissue should be judged as negative. PLA2R positive is defined as deposition in the subepithelial area of glomerulus along the capillary wall, with patterns of dot-line like, coarse or fine granules.