狼疮性肾炎的病理形态 发病机制及治疗

The relationship between renal histology,its mechanism and the treatment of Lupus nephutis

狼疮性肾炎(LN)传统地按照其肾活检组织形态进行治疗,近来研究认为单纯依靠形态学分类,而不触及病变的发生机制往往带来认识上的偏见。本文将已知LN的病理变化机制概括为4类:循环免疫复合物沉积;原位免疫复合物形成;血管炎性病变;血栓性微血管样病变。建议按照病变发生机制选择适当的免疫抑制药物(如激素、环磷酰胺、霉酚酸酯、普乐克复等),从而可以提高疗效,同时建议推广多靶点疗法,在减少各种免疫抑制剂剂量的条件下,多种药物并用,可以提高疗效,减轻副反应。

Summary： This paper emphasizes the importance of the mechanism of renal tissue damage in conducting treatment of lupus nephritis in addition to the renal histology. There are at least 4 kinds of mechanisms related to the renal tissue damage of LN including circulating immune complex deposition, in situ immune complex formation, vasculitic change and thrombotic mircoangiopathy. Treatment according to the mechanisms of tissue damage will give rise to a much better result as compared with the classic treatment based on morphology alone. Multi-target immune theapy has been recommended for treatment of those severe and complicated LN.