肾透明细胞癌合并磷脂酶A2受体相关膜性肾病3例及文献复习  

Clear cell renal cell carcinoma complicated with PLA2R-associated membranous nephropathy:three cases report and literature review

作　　者：孙淼鑫 吴浩文 王鼎鼎 王双宇 柴文秀 李芸[1] 李子薇 段丽萍[1] Sun Miao-xin;Wu Hao-wen;Wang Ding-ding;Wang Shuang-yu;Chai Wen-xiu;Li Yun;Li Zi-wei;Duan Li-ping(Department of Nephrology,Handan Central Hospital,Handan Key Laboratory of Precision Diagnosis and Treatment of Tumors,Handan 056001,China)

机构地区：[1]邯郸市中心医院肾内科,邯郸市肿瘤精准诊疗重点实验室,邯郸056001

出　　处：《临床肾脏病杂志》2025年第2期136-142,共7页Journal Of Clinical Nephrology

基　　金：2019年度河北省医学科学研究课题(20191842);2025年度河北省中医药类科学研究课题(2025605)。

摘　　要：目的 探讨肾细胞癌(renal cell carcinoma,RCC)合并磷脂酶A2受体(phospholipaseA2receptor,PLA2R)相关膜性肾病(membranous nephropathy,MN)的临床特点、治疗和转归。方法对3例邯郸市中心医院肾透明细胞癌合并PLA2R相关MN患者的临床、病理等资料及诊疗、转归等进行回顾性分析。以“肾细胞癌/Carcinoma, Renal Cell”和“磷脂酶A2受体/Receptors, Phospholipase A2”和“膜性肾病/Glomerulonephritis, Membranous”为检索词在万方、维普、中国知网、PubMed数据库进行文献检索。结果 3例患者均行肿瘤部分或全部切除,术后短期或长期应用干扰素或靶向药物,并予激素及免疫抑制剂或利妥昔单抗治疗,MN均完全缓解。经文献检索,国内外报道17例RCC合并PLA2R抗体阳性病例,加本文3例,20例患者发病年龄平均60.75岁,其中男13例,女7例。20例患者中死亡4例,维持性血液透析1例,2例预后不详,1例未缓解,12例部分或完全缓解。结论建议在手术治疗前提下,在充分抗凝等预防血栓栓塞等并发症基础上,对于RCC合并PLA2R相关MN患者给予适当的观察期,如无禁忌且肾病不缓解可予激素、免疫抑制剂及生物制剂等治疗,以提高患者生活质量,改善患者预后。Objective To explore the clinical characteristics,treatment and outcomes of renal cell carcinoma(RCC)combined with phospholipase A2 receptor(PLA2R)-related membranous nephropathy(MN).Methods The clinical and pathological data,diagnosis,treatment,and outcomes of three RCC patients with PLA2R-related MN were retrospectively analyzed.Relevant literatures were searched in Wanfang,VIP,CNKI,and PubMed databases using the following key words:“Renal Cell Carcinoma,Carcinoma,Renal Cell”and“phospholipase A2 Receptor,Receptors,Phospholipase A2”and“Membranous Nephropathy,Glomerulonephritis,Membranous”.Results Three RCC patients with PLA2R-related MN underwent partial or total tumor resection,with medications of short-term or long-term post-operative interferon or targeted drugs,hormone drugs and immunosuppressant or rituximab.They were followed up for 5-9 years.All the three cases were stable,with a complete remission of MN.After literature search,there were 17 cases of RCC combined with PLA2R-related MN at home and abroad, including 3 cases in this case report. The onset age of 20 patients ranged from 26 to 77 years old, with an average age of 60. 75 years. Among them, 13 were male and 7 were female, and 10 cases were clearly diagnosed as ccRCC. Of the 20 patients, 4 died, 1 underwent maintenance hemodialysis, 2 had unknown prognosis, 1 did not respond, and 12 experienced partial or complete response. Conclusion Un der the premise of surgical treatment and on the basis of adequate anticoagulation and other measures to prevent complications such as thromboembolism, RCC combined with PLA2R-related MN can be ob served in an appropriate observation period. If there are no contraindications and the kidney disease is not relieved, hormones, immunosuppressants and biological agents can be given to improve the quality of life and prognosis.

关 键 词：肾小球肾炎 膜性 受体 磷脂酶A2 癌 肾细胞 

分 类 号：R737.11[医药卫生—肿瘤] R692[医药卫生—临床医学]