IgA肾病(IgA nephropathy, IgAN)是多机制共同参与免疫介导的肾小球疾病,也是世界上最常见的原发性肾小球疾病,其病因及病理机制尚不明确,亦无特异性疗法,是国内外临床亟需解决的难题。现代医学研究表明IgA肾病与“肺–肠”轴和黏膜免...IgA肾病(IgA nephropathy, IgAN)是多机制共同参与免疫介导的肾小球疾病,也是世界上最常见的原发性肾小球疾病,其病因及病理机制尚不明确,亦无特异性疗法,是国内外临床亟需解决的难题。现代医学研究表明IgA肾病与“肺–肠”轴和黏膜免疫关系密切,通过干预“肺–肠”轴传导对肾脏病产生调控作用,或可成为治疗IgA肾病的新靶点。且传统药物对IgA肾病的治疗经过多年发展已展现出其显著疗效及副作用小的优势。本文就目前“肺–肠”轴与黏膜免疫在IgAN发病机制中作用的研究进展进行归纳探讨,以期为未来从“肺–肠”轴与黏膜免疫角度寻找IgAN新的治疗靶点提供思路及为研究拓宽思路。IgA nephropathy (IgAN) is an immune-mediated glomerular disease that involves multiple mechanisms and is the most common primary glomerular disease in the world. The etiology and pathogenesis of IgA nephropathy are still unclear, and there is no specific therapy for IgA nephropathy, so it is a problem that needs to be solved urgently for both domestic and foreign clinics. Modern medical research has shown that IgA nephropathy is closely related to the “lung-intestinal” axis and mucosal immunity, and that interfering with the “lung-intestinal” conduction has a regulatory effect on renal disease, which may become a new target for the treatment of IgA nephropathy. Moreover, after years of development, traditional medicines for IgA nephropathy have demonstrated their remarkable efficacy and low side effects. In this paper, we summarize and discuss the current research progress on the role of lung-intestinal axis and mucosal immunity in the pathogenesis of IgAN, with a view to providing ideas and broadening the mindset for future research on finding new therapeutic targets for IgAN from the perspective of lung-intestinal axis and mucosal immunity.展开更多
文摘IgA肾病(IgA nephropathy, IgAN)是多机制共同参与免疫介导的肾小球疾病,也是世界上最常见的原发性肾小球疾病,其病因及病理机制尚不明确,亦无特异性疗法,是国内外临床亟需解决的难题。现代医学研究表明IgA肾病与“肺–肠”轴和黏膜免疫关系密切,通过干预“肺–肠”轴传导对肾脏病产生调控作用,或可成为治疗IgA肾病的新靶点。且传统药物对IgA肾病的治疗经过多年发展已展现出其显著疗效及副作用小的优势。本文就目前“肺–肠”轴与黏膜免疫在IgAN发病机制中作用的研究进展进行归纳探讨,以期为未来从“肺–肠”轴与黏膜免疫角度寻找IgAN新的治疗靶点提供思路及为研究拓宽思路。IgA nephropathy (IgAN) is an immune-mediated glomerular disease that involves multiple mechanisms and is the most common primary glomerular disease in the world. The etiology and pathogenesis of IgA nephropathy are still unclear, and there is no specific therapy for IgA nephropathy, so it is a problem that needs to be solved urgently for both domestic and foreign clinics. Modern medical research has shown that IgA nephropathy is closely related to the “lung-intestinal” axis and mucosal immunity, and that interfering with the “lung-intestinal” conduction has a regulatory effect on renal disease, which may become a new target for the treatment of IgA nephropathy. Moreover, after years of development, traditional medicines for IgA nephropathy have demonstrated their remarkable efficacy and low side effects. In this paper, we summarize and discuss the current research progress on the role of lung-intestinal axis and mucosal immunity in the pathogenesis of IgAN, with a view to providing ideas and broadening the mindset for future research on finding new therapeutic targets for IgAN from the perspective of lung-intestinal axis and mucosal immunity.
文摘目的探讨原发性IgA肾病(IgA nephropathy,IgAN)患者不同IgM沉积强度与肾小球超微结构病变及临床病理的关系。方法收集155例IgAN患者的临床病理资料。分为IgM阴性(51例)、轻度(89例)和中度及以上沉积(15例)3组。比较3组间肾小球超微特征性结构、临床指标、MEST-C评分差异并分析与IgM沉积强度的影响因素。结果与IgM阴性、IgM轻度沉积组相比,IgM中度及以上沉积组24 h尿蛋白水平、IgG沉积、肾小管萎缩/间质纤维化(T)评分、足突融合(foot process effacement,FPE)程度更高,血白蛋白水平、淋巴细胞计数更低(P<0.05)。logistic结果显示FPE程度、T评分是IgM沉积强度的独立影响因素。结论IgM沉积强度与原发性IgAN患者FPE程度相关。FPE程度可协同临床病理评分更精准评估肾组织损伤及制定治疗方案。
