IgA肾病免疫抑制治疗最新进展

摘要

IgA肾病是世界范围内一种常见的肾小球疾病,从有明显的发病起20 ~25年内 15% ~40%的IgA患者进展到终末期肾病.患者尿蛋白的程度、高血压及病理损害程度是其主要的预后因素.目前IgA肾病尚无特效治疗,但是近5年来基于免疫抑制剂治疗IgA肾病的研究取得了显著进步.几项随机对照试验研究表明,对于肾功能尚好的患者,糖皮质激素或环磷酰胺可以有效地延缓肾功能减退;对于单纯血尿型IgA肾病,糖皮质激素联合硫唑嘌呤治疗更为有效;而对于肾功能已有损伤的患者,糖皮质激素联合吗替麦考酚酯的治疗效果较好.但至今尚无研究证明哪种方法是确切有效的.%IgA nephropathy( IgAN )is a world-wide disease and the cause of end-stage renal failure ( ESRF )in 15％ to 40％ of patients within 20 ～25 years from the apparent onset of disease.The amount of proteinuria, arterial hypertension and pathological damage are the major prognostic factors.No specific treatment has yet been established, but over the last 5 years the evidence based for immunosuppressive therapeutic approaches in IgAN patients has markedly improved.In addition to several studies with randomized controlled trials suggest that in patients with preserved renal function, corticosteroid or cyclophosphamide therapy can effectively prevent the development of progressive renal failure.For IgAN patients with isolated hematuria,corticosteroids combine with azathioprine therapy was more effective, whereas in patients with already impaired renal function, combination therapy consisting of corticosteroids and mycophenolate mof-etil was more effective.However, so far no study has firmly established which therapy is indeed available nowadays.