M型磷脂酶A2受体在膜性肾病中的中西医研究进展

Progress of M-Type Phospholipase A2 Receptor in Membranous Nephropathy

膜性肾病(membranous nephropathy, MN)是成人原发性肾病综合征的主要病因之一。其中病因不明者称为特发性膜性肾病(idiopathic membranous nephropathy, MN)。近几年来,IMN发病率逐年增加,且发病年龄日趋年轻化。现已成为继IgA之后的第一大原发性肾小球疾病。IMN的病程较长且疾病演变具有高度异质性:超过三分之一的患者出现自发缓解,而约三分之一的患者会在6~13年后进展为终末期肾病或肾衰竭。自本世纪初Beck等在IMN患者的肾脏足细胞中发现了M型磷脂酶A2抗原(PLA2R)后,诸多学者研究发现IMN产生的主要原因是PLA2R抗体含量的升高引起肾脏的膜的滤过作用受到损伤,进而引起机体的一系列免疫反应。中医学认为,膜性肾病归属于“水肿”“尿浊”范畴,其致病过程与机制与磷脂酶A2受体的参与关系密切。2021年KDIGO指南提出肾活检不再是诊断MN的金标准,血清PLA2R抗体阳性诊断MN有效性可与肾活检相当。而近年来研究显示PLA2R不仅可用于诊断,还可用于预后评估,为IMN患者选择治疗方案提供帮助。据此,本文就PLA2R在IMN中的研究进展作一综述,以期在现有研究基础上发挥PLA2R在IMN中的最大价值。

Membranous nephropathy (MN) is one of the main causes of adult primary nephrotic syndrome (PNS). Idiopathic membranous nephropathy (IMN) is a disease of unknown etiology. In recent years, the incidence of IMN is increasing year by year, and the age of onset is getting younger and younger. Now it has become the first primary glomerular disease after IGA. The course of IMN is long and the evolution of the disease is highly heterogeneous: more than one-third of patients experience spon-taneous remission, whereas approximately one-third progress to end-stage renal disease or renal failure after 6-13 years. Since the discovery of m-type phospholipase a2 antigen (PLA2R) in the po-docytes of IMN patients by Beck et al. at the beginning of this century, it has been found that the main reason of IMN production is that the increase of PLA2R antibody content leads to the damage of membrane filtration in kidney, and then causes a series of immune reactions in the body. Ac-cording to traditional Chinese medicine, membranous nephropathy belongs to the category of “Edema” and “Turbid urine”, and its pathogenesis and mechanism are closely related to the in-volvement of phospholipase a2 receptor. The 2021 KDIGO Guidelines suggest that renal biopsy is no longer the gold standard for the diagnosis of MN, and that serum PLA2R antibody positivity is as ef-fective in the diagnosis of MN as renal biopsy. In recent years, PLA2R has been shown to be useful not only in diagnosis, but also in prognostic assessment, and in the selection of therapy for IMN pa-tients. Based on this, this paper reviews the progress of PLA2R in IMN, in order to bring PLA2R into full play in IMN.