ABSTRACT
Objective:To analyze the antibody level of phospholipase A2 receptor (PLA2R) in Chinese patients with primary membrane nephropathy (PMN) and its correlation with clinical indicators, and to explore more suitable cut-off value for Chinese patients.Methods:All hospitalized patients with renal biopsy at Peking University People's Hospital from January to August 2018 were retrospectively reviewed. According to the primary disease, patients were divided into PMN group (including patients with idiopathic membranous nephropathy and atypical membranous nephropathy of unknown cause) and control group (other pathological types, including secondary membranous nephropathy patients). Their clinical and pathological characteristics were analyzed, and the level of serum PLA2R antibodies was detected using the method of enzyme-linked immunosorbent assay (ELISA). Spearman correlation was used to analyze the correlation between PMN patients' blood anti-PLA2R antibody level and clinical indicators. The risk factors of PMN were analyzed by logistic regression model, and the optimal cut-off value of PMN was analyzed by ROC curve.Results:A total of 354 patients were included in this study, including 114 patients in PMN group and 240 patients in control group. The age of PMN group was (51.7±14.1) years old and the ratio of male to female was 2.2∶1. The median concentration of PLA2R antibody in PMN group was 16.87 RU/ml [inter-quartile range ( IQR) 1.88-57.26], which was significantly higher than that in control group (1.43 RU/ml, IQR 1.20-1.62, P<0.001). In PMN group, the concentration of anti-PLA2R antibody was correlated with the 24-hour urine protein ration ( r=0.278, P=0.003) and urine erythrocyte ( r=0.190, P=0.043), but not with serum albumin ( r=-0.149, P=0.114) and serum creatinine ( r=0.136, P=0.149). The ROC curve showed that the sensitivity of distinguishing PMN from other diseases was 69.3% (95% CI 60.3%-77.0%), the specificity was 92.9%(95% CI 89.0%-95.5%), and the area under the curve was 0.859(95% CI 0.813-0.905) when the cut-off value was set as 2.28 RU/ml, which was significantly better than the cut-off value of 20.00 RU/ml (the sensitivity/specificity was 46.5%/97.5%) and 14.00 RU/ml (the sensitivity/specificity was 53.5%/97.1%). Conclusions:PLA2R antibody is one of the main pathogenic antibodies of PMN. In China, it is recommended to lower its cut-off value to 2.28 RU/ml, which can improve the sensitivity of distinguishing PMN from other pathological types without reducing specificity.
ABSTRACT
Objective To explore the surgical technique and clinical effect of percutaneous lumbar endoscopic surgery for central disc herniation.Methods From February 2010 to April 2014,69 consecutive patients (36 males and 33 females) with central lumbar disc herniation underwent percutaneous endoscopic surgery were included in the study.The average age was 31.33±8.27 years,ranging from 16 to 56 years.All operations were performed by increasing the initial puncture angle.First enter the intervertebral space through the ventral nerve root,and then move the guide rod tip step by step to the top of the protrusion.Operative time,intraoperative blood loss and complications were recorded.Visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) were followed up before surgery,immediately after surgery,3,12,24 months after surgery.The MacNab criteria were used to evaluate the efficacy at the last follow-up.During the follow-up period,X-ray,CT and MRI were performed to observe the instability and recurrence of the operative segment.Results All of the disc herniations were successfully removed without conversion to open surgery or revision.All patients were followed up for more than 24 months.The VAS scores of low back pain and leg pain were significantly lower than those before operation immediately,3 months,12 months and 24 months after operation (P＜0.01).The JOA score was significantly higher in monthly follow-up (P＜0.01),and ODI was significantly improved in 3 months and 24 months after operation (P＜ 0.01).There were 22 excellent cases (31.88％),44 good cases (63.77％),3 cases (4.35％) during the final follow-up,and the excellent and good rate was 95.65％.Dural sac injuries occurred in 1 patient and discharged from hospital in 2 weeks of symptomatic treatment.Lumbar instability and operative segment recurrence were not found during the follow-up period (2 years).Conclusion The improvement of the puncture angle and the technique innovation of the guide rod moving from intervertebral space to intraspinal canal step by step can effectively reduce the nerve root stimulation and injury during the puncture and the placement of the working passage,and significantly improve the clinical efficacy of percutaneous lumbar endoscopy in the treatment of central lumbar disc herniation.Microscopic management of the posterior longitudinal ligament can effectively reduce the recurrence rate and has no significant impact on spinal stability.