ObjectiveTo 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).MethodsPubMed, 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.ResultsA 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].ConclusionsThe 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.
ObjectiveTo analyze the cases of cryptogenic cerebral infarction complicated with patent foramen ovale (PFO) treated by interventional occlusion, and evaluate the efficacy and safety of occlusion of PFO on preventing the recurrence of cerebral infarction.MethodsA total of 24 patients with cerebral infarction complicated with PFO who underwent interventional occlusion from January 2015 to August 2018 in Mianyang Central Hospital were retrospectively analyzed. The data of these patients was collected, including relevant medical history, clinical examinations, and treatment processes. Detailed examinations (electrocardiogram, right heart contrast echocardiography, transcranial Doppler ultrasound foaming test, cranial imaging, etc.) were performed and the clinical manifestations were evaluated when patients returned to the outpatient department. Combining with regular telephone calls and outpatient follow-up, the recurrence of cerebral infarction and postoperative complications were evaluated.ResultsAmong the 24 patients, there were 11 males and 13 females, who were aged from 16 to 72 (with an average age of 49); the National Institutes of Health Stroke Scale Score was ≤5 in 19 patients, and was >5 in 5. The preoperative MRI and other examinations of the 24 patients showed that there were 21 cases of unilateral cerebral infarctions and 3 cases of bilateral cerebral infarctions; 10 cases of single lesions and 14 cases of multiple lesions; 9 cases of cortical infarctions and 15 cases of subcortical infarctions; 11 cases of lacunar infarctions and 13 cases of non-lacunar infarctions. Anterior circulation was involved in 14 cases, posterior circulation was involved in 8 cases, and both anterior and posterior circulations were involved in 2 cases. All the 24 patients underwent interventional occlusion successfully. No complications occurred during hospitalization or 3, 6, and 12 months of follow-up visits. No cerebral infarctions reoccurred.ConclusionsInterventional occlusion of PFO is effective on preventing the recurrence of cerebral infarction. And the operation is safe with rare complications.
