摘要Background:According to the renal phospholipase.A2 receptor (PLA2R) immunohistochemistry,idiopathic membranous nephropathy (iMN) could be categorized into PLA2R-associated and non-PLA2R-associated iMN.This study aimed to examine whether the non-PLA2R-associated iMN had any difference in clinical features compared with PLA2R-associated iMN.Methods:A total of 231 adult patients diagnosed as iMN were recruited to this retrospective study.Renal PLA2R expression was examined by immunofluorescence.Among these patients,186 (80.5 ％) with complete baseline clinical data w ere used for further study.Urinary protein excretion,serum albumin,and creatinine were analyzed.For those patients with follow-up longer than 1 year,the relationship between PLA2R and response to immunosuppressants were analyzed.The t-test was used for parametric analysis and the Mann-Whitney U-test was used for nonparametric analysis.Categorical variables were described as frequencies or percentages,and the data were analyzed with Pearson's Chi-square test or Fisher's exact test.Results:Of the 231 iMN patients,189 showed renal detectable PLA2R expression (81.8％).The baseline serum creatinine,serum albumin,and urine protein excretion were not significantly different between PLA2R-associated (n =145) and non-PLA2R-associated iMN patients (n =41).However,about 1/3 of the non-PLA2R-associated iMN had abnormal serological tests,significantly more common than PLA2R-associated iMN (31.7％ vs.8.3％,P =0.000).The non-PLA2R-associated iMN had lower C4 levels compared with PLA2R-associated iMN (P =0.004).The non-PLA2R-associated iMN patients also showed a better response to immunosuppressants (complete remission [CR] 42.9％;partial remission [PR] 14.3％) compared with PLA2R-associated iMN (CR 3.2％;PR 48.4％,P =0.004) at the 3rd month.Conclusions:There were no significant differences in serum creatinine,albumin,and urine protein excretion between PLA2R-associated and non-PLA2R-associated iMN,while the non-PLA2R-associated iMN patients showed more abnormal serological tests.The non-PLA2R-associated iMN seemed to respond more quickly to the immunosuppressive therapy compared with PLA2R-associated iMN.