膜性肾病生物标志物的研究现状与应用展望

Research status and application prospects of biomarkers for membranous nephropathy

膜性肾病(MN)是成人肾病综合征中最常见的病理类型,是成人终末期肾病的重要病因之一。MN的病程具有异质性,有1/3的患者会自发缓解或病情稳定,有1/3的患者病情则会持续进展,如未能及时诊断和规范治疗,将发展为终末期肾病。因此,早期发现预后不良患者,及时规范治疗和定期随访,具有重要的临床意义。肾活检是诊断MN的金标准。近年来,抗M型磷脂酶A2受体(PLA2R)抗体的临床应用极大地推动了MN的诊疗。最新的MN诊疗指南明确提出,在排除继发性MN后,符合MN临床表现和血清抗PLA2R抗体阳性患者不需要再进行肾活检来明确诊断。随着相关研究的不断深入,1型血小板反应蛋白7A域(THSD7A)等一系列新的MN潜在标志物被发现,对抗PLA2R抗体阴性MN的辅助诊断有较高的临床价值。因此,加强MN新型生物标志物的临床应用研究,综合运用相关生物标志物,将有助于推进MN的精准诊疗。

Membranous nephropathy(MN)is the most common pathological type of adult nephrotic syndrome and a significant contributor to adult end-stage renal disease.The course of MN varies,with 1/3 patients experiencing spontaneous remission or stable disease,while 1/3 patients continue to progress.Without timely diagnosis and standardized treatment,MN can lead to end-stage renal disease.Therefore,early determination of patients with poor prognosis,timely standardized treatment and regular follow-up are crucial.Renal biopsy is the gold standard for diagnosing MN.Recently,the clinical application of anti-M-type phospholipase A2 receptor(PLA2R)antibody determination has improved the diagnosis and treatment of MN.According to the latest MN diagnosis and treatment guidelines,it is now clear that renal biopsy is not necessary to confirm the diagnosis of MN after ruling out secondary MN.With research progress,several new potential markers for MN,including thrombospondin type1 domaincontaining 7A(THSD7A),have been discovered.These markers are valuable for assisting in the diagnosis of anti-PLA2R antibody-negative MN.Therefore,it is important to conduct further clinical research on these new MN biomarkers and utilize a comprehensive approach to their application in order to enhance the accuracy of MN diagnosis and treatment.