膜性肾病诊断和治疗的研究进展

Progress in the diagnosis and treatment of membranous nephropathy

膜性肾病(membranous nephropathy,MN)是成人肾病综合征最常见的病理类型,目前诊断主要依靠肾穿刺活检。新近研究发现应用磷脂酶A2受体、Ⅰ型血小板反应蛋白7A域等特异性生物标志物对MN进行无创诊断、疾病变化监测及预后评估具有重要的意义,可部分替代肾穿刺活检。随着这些生物标志物的发现,进一步证实了MN中免疫相关因素的致病作用,因此以利妥昔单抗为首的靶向治疗药成为治疗MN的一种新的选择。此外,还有一些其他类型的抗CD20的单克隆抗体被发现可以成为利妥昔单抗耐药患者的替代方案。本文针对MN诊断和治疗的研究进展进行综述。

Membranous nephropathy(MN)is the most common pathological type of adult nephrotic syndrome.At present,the diagnosis mainly depends on renal biopsy.Recent studies have found that the specific biomarkers phospholipase A2 receptors and thrombospondin type 1 domain⁃containing 7A have importantsignifi⁃cance as a non⁃invasive procedure in diagnosis of MN,detection of disease changes,and assessment of prognosis,which can partly replace renal biopsy.Thanks to the discovery of these biomarkers,the pathogenic effect of immune⁃related factors in MN has been further confirmed.Therefore,targeted therapeutic drugs led by rituximab have become a new choice for the treatment of MN.In addition,other types of anti⁃CD20 monoclonal antibodies have been found to be an alternative for rituximab⁃resistant patients.This article reviews the research progress in the diagnosis and treatment of MN.