摘要
膜性肾病(membranous nephropathy,MN)是成人肾病综合征常见的病理类型之一,按病因分为特发性膜性肾病(idiopathic membranous nephropathy,IMN)和继发性MN。IMN约占MN发病人群的80%,治疗多采用糖皮质激素联合烷化剂或钙调神经磷酸酶抑制剂(calcineurin in-hibitors,CNIs),但烷化剂的致癌风险及CNIs应用后的疾病高复发等缺点,使得这两类药物的应用受到限制。在MN的致病机制中,B细胞作为抗原呈递细胞起着重要作用。新型免疫抑制剂利妥昔单抗(rituximab,RTX)是一种特异性针对B细胞表面抗原CD20的单克隆抗体,在国内外多项临床研究中,RTX单药或联合其他药物治疗MN均获肯定的疗效。单药与联合给药,哪一种治疗方案使得患者获益更多,目前尚无定论。
Membranous nephropathy(MN)is a common pathological type of adult nephrotic syndrome.According to the etiology,MN is divided into idiopathic membranous nephropathy(IMN)and secondary membranous nephropathy(SMN).IMN accounts for around 80% of MN patients.Glucocorticoid plus alkylating agents or calcineurin inhibitors(CNIs)are frequently prescribed.However,carcinogenic risk of alkylating agents and a high recurrence of disease after the dosing of CNIs have limited the applications of these two types of drugs.In the pathogenesis of MN,B cells play an important role of acting as antigen presenting cells.Rituximab(RTX),a novel immunosuppressive agent,is a monoclonal antibody specific to B cell surface antigen CD20.In many recent clinical studies,RTX alone or plus other drugs has demonstrated a definite efficacy for MN.Whether or not patients benefit more from a single drug or a combination therapy is yet to be determined.
作者
张超
廖晖
李荣山
Zhang Chao;Liao Hui;Li Rong-shan(Department of Nephrology,the Fifth Hospital of Shanxi Medical University,Taiyuan 030012,China;Department of Pharmacy,the Fifth Hospital of Shanxi Medical University,Taiyuan 030012,China)
出处
《临床肾脏病杂志》
2024年第1期65-69,共5页
Journal Of Clinical Nephrology
基金
中央引导地方科技发展资金项目(YDZJSX2021C027)
山西省医学重点科研项目(2020XM02)。
关键词
膜性肾病
利妥昔单抗
磷脂酶A2受体
Membranous nephropathy
Rituximab
Phospholipase A2 receptors
