Objective To systematically review the value of autoantibodies to serum M-type phospholipase A2 receptor (PLA2R) in predicting spontaneous and therapeutic remission rates of idiopathic membranous nephropathy (IMN).Methods PubMed, Embase, Clinical Trails, China National Knowledge Infrastructure, China Biology Medicine, Wanfang, and CQVIP databases were searched for studies on remission of IMN associated with PLA2R antibody published from inception to December 2020. Binary variables were extracted according to PLA2R antibody positive and negative groups. Newcastle-Ottawa Scale was used to evaluate the literature quality. Meta analyses were performed in RevMan 5.3 software, and relative risk (RR) and its 95% confidence interval (CI) were calculated. Publication bias was analyzed by Stata 15.0 software.Results A total of 15 articles were included in the meta-analysis, all of which were cohort studies (erther retrospective or prospective). A total of 1 452 patients with IMN were enrolled in the study. Among them, the spontaneous remission rate of IMN patients without immunosuppressive therapy was observed in 6 articles, and the therapeutic remission rate of IMN patients receiving immunosuppressive therapy was observed in 13 articles (both spontaneous remission rate and therapeutic remission rate were observed in 4 articles). Meta-analysis results showed that the spontaneous remission rate in the PLA2R antibody positive group was significantly lower than that in the PLA2R antibody negative group [RR=0.73, 95%CI (0.55, 0.97), P=0.03]. For IMN patients receiving immunosuppressive therapy, the remission rate in the PLA2R antibody positive group was significantly lower than that in the PLA2R antibody negative group at diagnosis [RR=0.81, 95%CI (0.72, 0.92), P=0.000 9].Conclusions The spontaneous remission rate of IMN with PLA2R antibody positive at diagnosis and the remission rate under the immunosuppressive therapy are significantly lower than those with PLA2R antibody negative. For IMN patients with negative PLA2R antibody, non-immunosuppressive therapy may be preferred to reduce the risk of adverse reactions due to its relatively high spontaneous remission rate. For IMN patients with PLA2R antibody positive, a more aggressive, longer-term immunosuppressive therapy may be required, given its lower spontaneous and therapeutic remission rates.

Citation： ZHANG Shanshan, NIE Limin, YAO Xing, XUE Lanfen. Predictive value of M-type phospholipase A2 receptor antibody for spontaneous remission rate and therapeutic remission rate in idiopathic membranous nephropathy: a meta-analysis. West China Medical Journal, 2021, 36(1): 82-90. doi: 10.7507/1002-0179.201909114 Copy