特发性膜性肾病的发病机制、动物模型及治疗策略

Pathogenesis,animal models and treatment strategy of idiopathic membranous nephropathy

特发性膜性肾病(idiopathic membranous nephropathy,IMN)是肾病综合征和终末期肾病的主要病因之一。随着我国IMN发病率逐年增加,其在临床受到了更多的重视。随着IMN新生物标志物的逐步发现,传统的动物模型已不能适应IMN研究的需求。同时,由于种族、环境、经济、生活习惯等因素的差异,IMN治疗尚有较多争议。因此,本文首先综述了IMN近来除M型磷脂酶A2受体(M-type phospholipase A2 receptor,PLA2R)外的一些最新的生物标志物,如补体因子H(factor H)、信号素-3B(semaphorin-3B)、经表皮生长样因子1(nerve epidermal growth factor-like 1,NELL1)等在IMN早期诊断中的作用;然后介绍了目前针对PL A2R和补体系统研发的新动物模型方面的进展;最后讨论了IMN治疗药物策略的选择。除早期使用的肾素血管紧张素系统抑制剂、糖皮质激素、环磷酰胺、钙调神经磷酸酶抑制剂(calcineurin inhibitor,CNI)、促肾上腺皮质激素(adreno-corticotropic-hormone,ACTH)外,根据最新的循证医学证据,着重介绍了新的生物制剂如利妥昔单抗、奥滨尤妥珠单抗、贝利优单抗的临床应用和补体抑制剂的研发进展。IMN的发病机制、新生物标志物和新动物模型的研究进展为IMN的深入研究提供了良好的基础。治疗方面,充分考虑不同种族人群的特点,优化我国IMN患者的诊断和治疗,改善其预后,是亟待解决的突出问题。

Idiopathic membranous nephropathy(IMN)is one of the main causes of nephrotic syndrome and end-stage renal disease.With an increasing prevalence,IMN has received considerable attention in China.With the discovery of new biomarkers of IMN,the traditional animal model of IMN cannot meet the requirements of research.Moreover,due to the differences of race,environment,economy,living habits and other factors,a consensus has not yet been reached for the treatment of IMN.Based on studies published in recent years,this review firstly discusses advances in the new biomarkers,in addition to M-type phospholipase A2 receptor(PLA2R),such as nerve epidermal growth factor-like 1(NELL1).Secondly,the progress of new animal models for PLA2R and complement system are introduced.Finally,we detail the advantages and disadvantages of current therapeutic strategies for IMN.In addition to the early drug use of renin-angiotensin system inhibitors,glucocorticoids,cyclophosphamide and calcineurin inhibitors(CNI)and adrenocorticotropic hormone(ACTH),we focus on the introduction of new biological agents based on the latest evidence-based medical evidence,such as rituximab,obinutuzumab,belimumab and the latest research and development progress of complement inhibitors.The esearch progress of IMN pathogenesis,new biomarkers and new animal models provides a good foundation for the in-depth study of IMN.In terms of treatment,fully consider the characteristics of the Chinese population.Therefore,optimizing the diagnosis and treatment of Chinese patients with IMN and improving their prognoses are prominent problems requiring urgent resolution.