肠道菌群在IgA肾病发病与治疗中的作用研究进展  

Research progress in the role of gut microbiota in the pathogenesis and treatment of IgA nephropathy

作　　者：李郡如 欧阳彦[1] 谢静远[1] LI Junru;OUYANG Yan;XIE Jingyuan(Department of Nephrology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上海200025

出　　处：《上海交通大学学报（医学版）》2023年第8期1044-1048,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金重点国际(地区)合作研究项目(82120108007);国家自然科学基金(82270739,81870460,81570598,81370015,81900656);上海市2021年度“科技创新行动计划”优秀学术带头人计划(21XD1402000);上海市科委科技创新行动计划(22140904000);上海市临床重点专科(shslczdzk02502);上海申康医院发展中心“促进市级医院临床技能与临床创新三年行动计划”(SHDC2020CR6017);上海交通大学“交大之星”计划医工交叉研究项目(YG2019ZDA18,YG2019QNA37);上海市教育委员会高峰高原学科建设计划(20152207)。

摘　　要：IgA肾病(IgA nephropathy,IgAN)是全球最常见的肾小球肾炎,病理上以糖基化缺陷IgA1(glycosylation-deficient IgA1,Gd-IgA1)与其特异性抗体(Gd-IgA1-IgG)形成的免疫复合物在肾小球系膜区弥漫沉积为主要特征。尽管Gd-IgA1产生的原因和机制并不清楚,但越来越多的研究发现,产生Gd-IgA1的浆细胞主要来自肠道相关淋巴组织,由此形成“肠肾轴”理论。随之的多项研究发现在IgAN患者与健康人群之间,肠道菌群及其代谢物的组成存在明显差异。进一步研究发现肠道菌群可能参与IgAN发生和疾病进展,且调节肠道微生物的多项干预措施,如益生菌应用、粪便微生物群移植、调节肠道免疫等可用于IgAN的治疗;其中口服布地奈德控释胶囊为靶向回肠末端的肠道局部激素治疗,已被证实可以减少IgAN患者的尿蛋白水平并延缓肾衰。肠道菌群作为IgAN预防、诊断及治疗靶点具有广阔的前景,需要进一步的研究。As the most common form of glomerulonephritis worldwide,IgA nephropathy(IgAN)is characterized by the diffuse deposition of immune complexes formed by glycosylation-deficient IgA1(Gd-IgA1)and its specific antibodies(Gd-IgA1-IgG)in the glomerular mesangium.Although the mechanisms of Gd-IgA1 production are still unknown,there is accumulating evidence that Gd-IgA1-producing plasma cells are primarily derived from gut-associated lymphoid tissue,giving rise to the"gut-kidney axis"theory.Further research has discovered that gut microbiota may be involved in IgAN development and progression,and that several interventions to regulate gut microbiota,such as probiotics,fecal microbiota transplantation,and intestinal immunity modulation,may be used in the treatment of IgAN.In patients with IgAN,targeted-release formulation-budesonide has been shown to reduce urinary protein levels and delay kidney progression.Gut microbiota has promising potential as a preventive,diagnostic and therapeutic target for IgAN,and further research is needed.

关 键 词：IGA肾病 肠道菌群 肠肾轴 黏膜免疫 治疗 

分 类 号：R692.3[医药卫生—泌尿科学]