特发性膜性肾病的治疗新进展

Update in the Treatment of Idiopathic Membranous Nephropathy

膜性肾病临床表现为肾病综合征(大量蛋白尿、低蛋白血症、高度水肿、高脂血症),其病理学改变为肾小球毛细血管袢上皮侧可见大量免疫复合物沉积。而特发性膜性肾病(IMN)是指除继发因素外的原因不明的膜性肾病。目前,其机制尚未明确。IMN的常用治疗方案是激素联合环磷酰胺治疗,但有部分患者治疗效果不佳或存在应用禁忌。因此,越来越多的新型免疫抑制剂、中药及其他方式治疗逐渐应用于临床,但未来仍需要大样本的随机对照试验证实。

The clinical manifestation of membranous nephropathy is nephrotic syndrome（a large amount of proteinuria,hypoalbuminemia,high edema,hyperlipidemia）,and the pathological changes of membranous nephropathy are the deposition of immunocomplexes on the epithelial side of the glomerular capillary loops.Idiopathic membranous nephropathy（IMN） is a membranous nephropathy with unknown causes other than secondary factors.At present,its mechanism is not clear yet.The common treatment of IMN is hormone combined with cyclophosphamide treatment,but poor therapeutic effect or contraindication exist in some patients.Therefore,more and more new immunosuppressive agents,traditional Chinese medicine and other treatment methods are gradually applied in clinical practice,but they still need to be validated by large-sample randomized controlled trials in the future.