M型磷脂酶A2受体与膜性肾病的临床诊治:进展与争议  

Value of M-type phospholipase A2 receptor in clinical diagnosis and treatment of membranous nephropathy:recent advances and current controversies

作　　者：王慧[1] 江嫚 张迪 汪玉琴 Wang Hui;Jiang Man;Zhang Di;Wang Yu-qin(Department of Nephrology,Affiliated Union Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院肾内科,武汉430022

出　　处：《临床肾脏病杂志》2021年第1期68-73,共6页Journal Of Clinical Nephrology

摘　　要：血清抗M型磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体对特发性膜性肾病的诊断敏感性为70%~80%,特异性高达95%以上。本综述主要从PLA2R入手,阐述其在膜性肾病的发病机制、诊断、治疗、预后方面的进展,并探讨目前仍存在的一些争议:如何判定血清抗PLA2R抗体阳性以及其阳性能否排除继发性膜性肾病;能否通过抗PLA2R抗体滴度来预测患者预后情况、初判启动免疫抑制治疗时机、指导免疫抑制剂的类型及使用时间;以及探讨抗PLA2R抗体与移植后膜性肾病复发、新发的关系等。从而对PLA2R在膜性肾病中的意义产生全方位的认识,便于指导临床工作。The sensitivity of serum anti-M-type phospholipase A2 receptor antibodies(anti-PLA2R Abs)is 70%~80%in idiopathic membranous nephropathy and the specificity over 95%.This article reviewed the latest research advances on the pathogenesis,diagnosis,treatment and prognosis of PLA2R in membranous nephropathy(MN)and discussed some current controversies as well.The positivity of anti-PLA2R Abs was defined and whether or not positive anti-PLA2R Abs adequately excluded secondary membranous nephropathy.Also discussed were the issues of whether or not quantifying anti-PLA2R Abs predicted prognosis and determined the starting,timing and duration of immunosuppressive treatment.The relationship was examined between anti-PLA2R Abs titer and recurrent and de novo MN in transplanted kidney as well.The goal was to fully understand the significance of PLA2R in membranous nephropathy and guide clinical practices.

关 键 词：磷脂酶A2受体 抗M型磷脂酶A2受体抗体 膜性肾病 

分 类 号：R692[医药卫生—泌尿科学]