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磷脂酶 A2受体抗体在特发性膜性肾病中的诊断价值
目的：探讨抗磷脂酶A2受体（PLA2R）抗体在成人特发性膜性肾病（IMN）中的诊断作用和联合监测价值。方法回顾性研究，选择2013年1月至2014年6月期间辽宁中医药大学附属医院、中国医科大学附属盛京医院肾内科住院患者肾活检明确诊断的IMN患者48例，非特发性膜性肾病（ NIMN）患者115例（其中过敏性紫癜性肾病亚组23例，狼疮性肾病亚组39例，IgA肾病亚组24例，肿瘤相关肾病亚组29例）；选择辽宁中医药大学附属医院临床体检中心体检健康的志愿者35例作为对照组。采用间接免疫荧光法（IIF）检测各组患者血清中PLA2R抗体，并观察抗体荧光强度与IMN组病理分期及24小时尿蛋白（24 h PRO）、血尿素氮（UREA）、胱抑素C（CYSC）、血尿酸（URIC）、肾小球滤过率估算值（ eGFR）等进行相关性分析。组间比较采用t检验，χ2做相关性分析。结果（1）48例IMN组血清标记的基质片中，37例标本PLA2R抗体基质荧光呈阳性，阳性率为77．08％；NIMN组中，基质胞浆荧光均为阴性。 IMN组患者血清PLA2R抗体的敏感度为77．08％，其特异度达100．00％。（2）与对照组比较，IMN组各肾功能主要相关指标均明显增高，差异有统计学意义（对照组与IMN组UREA分别为4．12±1．25、6．02±2．28， t＝4．446，P＝0．00；UA分别为262±49、331±112， t＝2．577，P＝0．017；CYSC分别为0．78±0．21、1．16±0．27， t＝4．63，P＝0．00）；NIMN组各亚组肾功能主要相关指标也存在差异有统计学意义（对照组与过敏性紫癜性肾病亚组UREA分别为4．12±1．25、5．43±1．84，t＝3．606，P＝0．0002；UA分别为262±49、299±51， t＝1．050，P＝0．03；CYSC分别为0．78±0．21、1．06±0．31， t＝1．672，P＝0．02。对照组与狼疮性肾病亚组UREA分别为4．12±1．25、5．90±2．20，t＝4．225，P＝0．00；UA分别为262±49、342±92，t＝2．409，P＝0．026；CYSC分别为0．78±0．21、0．92±0．24， t＝1．674，P＝0．00。对照组与IgA肾病亚组UREA分别为4．12±1．25、6．69±2．87，t＝4．756，P＝0．00；UA分别为262±49、361±52， t＝4．598，P＝0．00；CYSC分别为0．78±0．21、1．30±0．36， t＝4．752，P＝0．00。对照组与肿瘤相关肾病亚组UREA分别为4．12±1．25、5．02±1．70，t＝3．626，P＝0．002；UA分别为262±49、289±92， t＝0．05，P＝0．01；CYSC分别为0．78±0．21、0．98±0．20， t＝1．1，P＝0．01）。 IMN组与NIMN组中的4个亚组肾功能相关指标比较差异无统计学意义（P＞0．05）。（3） IMN组的PLA2R抗体荧光强度与24 h PRO呈正相关（r＝0．877， P＝0．00），与URIC呈正相关（r＝0．766，P＝0．00）。（4）IMN组血清中抗PLA2R抗体水平与病理Ⅰ期、Ⅱ期、Ⅲ期分期无相关性（ r值分别为0．087、0．194、0．182；P值分别为0．598、0．399、0．667），但抗体阳性率（Ⅰ期37．50％、Ⅱ期84．85％、Ⅲ期85．71％）可随着病情严重程度有递增趋势。结论PLA2R抗体可能是新的IMN的实验室诊断指标。（中华检验医学杂志，5－599）
Abstract：
Objective To investigate the diagnostic value and monitoring application of anti-phospholipase A2 receptor antibodies ( PLA2R ) in patients with idiopathic membranous nephropathy ( IMN) .Methods A retrospective study was used .48 patients were diagnosed as idiopathic membranous nephropathy by puncturing kidney from January of 2013 to June of 2014 in the Hospital of Liaoning Traditional Chinese Medical University and Shengjing Hospital of China Medical University were included. 43 patients were diagnosed as non-idiopathic membranous nephropathy ( NIMN ).35 healthy volunteers were selected as control groups.Serum PLA2R were detected by indirect immunofluorescence.The intensity of antibodies fluorescence and the level of urine protein in 24 hours(24 h PRO) ,serum UREA ,serum CYSC, serum UA,GFR were compared in each groups.Measurement data was shown as mean ±Count data was shown as frequency or composition, t test andχ2 test were used as statistical method.Results (1) Among 48 cases with IMN,37 cases showed positive PLA2R (positive rate 77.08%).All of cases were negative in NIMN group.The sensitivity and the specificity of serum PLA2R were 77.08%and 100%.(2) Compared with control groups, the levels of UREA, CYSC and UA were found statistically significant differences in patients with IMN ( P &0.05 ) .( The levels of UREA in control groups and IMN groups respectively:4.12 ±1.25,6.02 ±2.28, t =4.446,P=0.00;UA:262 ±49,331 ±112,t =2.577,P =0.017;CYSC:0.78 ±0.21,1.16 ±0.27,t=4.63,P=0.00.) Compared with control groups, the levels of main items in patients with NIMN had statistically significant differences (P&0.05).(The levels of UREA in control groups and Allergic purpura nephropathy subgroups respectively:4.12 ±1.25,5.43 ±1.84,t=3.606,P=0.000 2;UA:262 ±49, 299 ±51, t=1.050,P=0.03;CYSC:0.78 ±0.21, 1.06 ±0.31, t=1.672,P=0.02.The levels of UREA in control groups and lupus nephropathy subgroups respectively:4.12 ±1.25, 5.90 ±2.20,t=4.225,P=0.00;UA:262 ±49, 342 ±92,t=2.409,P=0.026;CYSC:0.78 ± 0.21,0.92 ±0.24, t =1.674, P =0.00.The levels of UREA in control groups and IgA nephropathy subgroups respectively:4.12 ±1.25,6.69 ±2.87,t=4.756,P=0.00;UA:262 ±49,361 ±52,t=4.598, P=0.00;CYSC:0.78 ±0.21, 1.30 ±0.36,t=4.752,P=0.00.The levels of UREA in control groups and tumor associated nephropathy subgroups respectively: 4.12 ±1.25, 5.02 ±1.70, t =3.626, P =0.002;UA:262 ±49, 289 ±92,t=0.05,P=0.01;CYSC:0.78 ±0.21, 0.98 ±0.20,t=1.1,P=0.01.) There was no statistically significant differences between IMN group and NIMN ( P &0.05 ) . ( 3 ) Positive correlation were found between 24 h PRO(r=0.877,P=0.00),serum UA (r=0.766,P=0.00 ) with the level of PLA2R antibodies fluorescence intensity.( 4 ) There were no correlation between serum PLA2R antibody with IMN pathology aging (r=0.087,0.194,0.182;P=0.598,0.399,0.667).PLA2R positive rate(Ⅰstage:37.50%,Ⅱstage:84.85%, Ⅲstage 85.71%) may increases with the increasing of illness severity.Conclusion Serum PLA2R antibody would be a new laboratory diagnosis standard in patients with IMN.(Chin J Lab Med, -599 ) Objective To investigate the diagnostic value and monitoring application of anti-phospholipase A2 receptor antibodies ( PLA2R ) in patients with idiopathic membranous nephropathy ( IMN) .Methods A retrospective study was used .48 patients were diagnosed as idiopathic membranous nephropathy by puncturing kidney from January of 2013 to June of 2014 in the Hospital of Liaoning Traditional Chinese Medical University and Shengjing Hospital of China Medical University were included. 43 patients were diagnosed as non-idiopathic membranous nephropathy ( NIMN ).35 healthy volunteers were selected as control groups.Serum PLA2R were detected by indirect immunofluorescence.The intensity of antibodies fluorescence and the level of urine protein in 24 hours(24 h PRO) ,serum UREA ,serum CYSC, serum UA,GFR were compared in each groups.Measurement data was shown as mean ±Count data was shown as frequency or composition, t test andχ2 test were used as statistical method.Results (1) Among 48 cases with IMN,37 cases showed positive PLA2R (positive rate 77.08%).All of cases were negative in NIMN group.The sensitivity and the specificity of serum PLA2R were 77.08%and 100%.(2) Compared with control groups, the levels of UREA, CYSC and UA were found statistically significant differences in patients with IMN ( P &0.05 ) .( The levels of UREA in control groups and IMN groups respectively:4.12 ±1.25,6.02 ±2.28, t =4.446,P=0.00;UA:262 ±49,331 ±112,t =2.577,P =0.017;CYSC:0.78 ±0.21,1.16 ±0.27,t=4.63,P=0.00.) Compared with control groups, the levels of main items in patients with NIMN had statistically significant differences (P&0.05).(The levels of UREA in control groups and Allergic purpura nephropathy subgroups respectively:4.12 ±1.25,5.43 ±1.84,t=3.606,P=0.000 2;UA:262 ±49, 299 ±51, t=1.050,P=0.03;CYSC:0.78 ±0.21, 1.06 ±0.31, t=1.672,P=0.02.The levels of UREA in control groups and lupus nephropathy subgroups respectively:4.12 ±1.25, 5.90 ±2.20,t=4.225,P=0.00;UA:262 ±49, 342 ±92,t=2.409,P=0.026;CYSC:0.78 ± 0.21,0.92 ±0.24, t =1.674, P =0.00.The levels of UREA in control groups and IgA nephropathy subgroups respectively:4.12 ±1.25,6.69 ±2.87,t=4.756,P=0.00;UA:262 ±49,361 ±52,t=4.598, P=0.00;CYSC:0.78 ±0.21, 1.30 ±0.36,t=4.752,P=0.00.The levels of UREA in control groups and tumor associated nephropathy subgroups respectively: 4.12 ±1.25, 5.02 ±1.70, t =3.626, P =0.002;UA:262 ±49, 289 ±92,t=0.05,P=0.01;CYSC:0.78 ±0.21, 0.98 ±0.20,t=1.1,P=0.01.) There was no statistically significant differences between IMN group and NIMN ( P &0.05 ) . ( 3 ) Positive correlation were found between 24 h PRO(r=0.877,P=0.00),serum UA (r=0.766,P=0.00 ) with the level of PLA2R antibodies fluorescence intensity.( 4 ) There were no correlation between serum PLA2R antibody with IMN pathology aging (r=0.087,0.194,0.182;P=0.598,0.399,0.667).PLA2R positive rate(Ⅰstage:37.50%,Ⅱstage:84.85%, Ⅲstage 85.71%) may increases with the increasing of illness severity.Conclusion Serum PLA2R antibody would be a new laboratory diagnosis standard in patients with IMN.
Niu Guanghua
Wang Baishan
Guo Hongyang
Cui Baihui
Zhang Cheng
作者单位：
辽宁中医药大学附属医院临床检验中心, 沈阳,110032
中国医科大学附属盛京医院检验科
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2014年辽宁省自然科学基金
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磷脂脂肪酸在地下水微生物生态学中的应用及存在的若干问题
磷脂脂肪酸(PLFA)是研究地下水微生物生态的一种新兴技术,它比基于培养基的传统方法有许多明显的优势,但同时也存在一些需要解决的问题.样品中的PLFA总量可以通过转换因子估算地下水微生物的生物量,但微生物群落组成的差异和环境的物理变化都是潜在的误差来源,以传统微生物技术互补和选择合适的转换因子可提高结果的可靠性;PLFA还可以被用来指示地下水微生物在各种环境压力下的生理状态;用特定的PLFA生物标志物、PLFA的组成模式、指纹技术来描述地下水微生物的群落结构和变化特征时,存在的主要问题是不同微生物PLFA的重叠、背景值的干扰和环境因子变化的影响,以PLFA技术为主导,借助于数学统计方法,结合传统微生物技术、核酸鉴定、同位素示踪等多种技术可望有效地消除各种干扰因子,从而揭示完整的地下水微生物的生理生态,为地下水污染的生物修复提供理论指导.
作者单位：
清华大学核能技术设计研究院,北京,100084;中国科学院东北地理与农业生态研究所,吉林,长春,130012
中国科学院东北地理与农业生态研究所,吉林,长春,130012
吉林建筑工程学院,吉林,长春,130021
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吉林省科技厅科研项目，国家自然科学基金
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改良甘油三酯酶法试剂盒测定（GPO-PAP法）评价
甘油三酯来自食物中脂肪的分解。肝脏也能将血液中的某些糖类转化为甘油三酯。甘油三酯（TG）是由一分子甘油与三分子脂肪酸组成的酯，每一TG分子中可以含有2~3种不同的脂肪酸，因而其组成是复杂的，血清中90%~95%是TG，血清TG测定方法一般可分为化学法、酶法和色谱法3大类[1]。早期测定方法是以总脂质与胆固醇和磷脂之差估算。化学法用有机溶剂抽提标本中的TG，去除抽提液中磷脂等干扰物后，用碱水解（皂化）TG，以过碘酸氧化甘油生成甲醛，然后用显色反应测甲醛。比较准确的是二氯甲烷-硅酸-变色酸法此法抽提完全、能去除磷脂及甘油干扰、变色酸显色灵敏度高、显色稳定，但因操作步骤繁多、技术要求高而不适于常规工作应用。气相色谱法主要用作参考系统中决定性方法的建立及参考物质的制备与定值，此法费用昂贵，样品处理复杂，难以推广应用。酶法（GPO-PAP法）具有简便快速、微量、精密度高的优点，且特异性强，易于达到终点，线性范围宽。该法不增加试剂成本和工作量，适合自动化分析，国内外均推荐GPO-PAP法作为临床测定。本文现将改良后的甘油三酯测定试剂盒评价结果报告如下。
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独山县人民医院,贵州 黔南,558200
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