儿童急性链球菌感染后肾小球肾炎的发病机制及其诊治进展

Advancement in understanding acute poststreptococcal glomerulonephritis

近来国外在识别致病的链球菌抗原方面取得了多方面进展。肾炎相关链球菌纤溶酶受体以及链球菌致热外毒素B被认为是主要致病因素。与健康对照组相比,急性链球菌感染后肾小球肾炎患者体内发现包括人类白细胞抗原DRB1-03011在内的易感因素的高表达。有报道,可逆性后脑白质脑病和自身免疫性溶血性贫血可能与急性链球菌感染后肾小球肾炎相关。此外,对于该病的治疗,目前大多数仍主张采取保守治疗,对于有不良预后因素存在的患儿是否采取更加积极的治疗仍值得商榷。严重A族链球菌感染,包括急性链球菌感染后肾小球肾炎,仍是发展中国家导致疾病和死亡的一个主要原因。对于发病机制的研究将有助于研制疫苗以及预防。文章回顾了近年来国内外急性链球菌感染后肾小球肾炎的有关发病机制、宿主易感性、临床多样性以及治疗的最新的研究进展。

Acute poststreptococcal glomerulonephritis remains a major ailment in children worldwide as the commonest acute glomerulonephritis.Recent advances in knowledge of this disease,including pathogenesis,host susceptibility factors,various clinical symptoms as well as treatments was reviewed in this article.Several streptococcal antigens were recently identified to be involved in the pathogenesis of acute poststreptococcal glomerulonephritis,including nephritis-associated streptococcal plasmin receptor and streptococcal pyrogenic exotoxin B as putative nephritogens.Acute poststreptococcal glomerulonephritis patients were found to express higher host susceptibility factors,namely,HLA-DRB1 03011,comparing to healthy controls.For clinical presentations,acute poststreptococcal glomerulonephritis-induced reversible posterior leukoencephalopathy and autoimmune hemolytic anemia were recently reported.Currently,conservative treatment is standard,while more aggressive remedy on patients with poor prognostic factors remains controversial.Because group A streptococcal-induced acute poststreptococcal glomerulonephritis is still a major cause of morbidity in developing world,updated understanding of this ailment is critical for clinicians to diagnose and treat the disease correctly.At the same time,more understanding of the pathogenesis will help the development of vaccine as well as prevention.