切换至 "中华医学电子期刊资源库"

中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 62 -67. doi: 10.3877/cma.j.issn.1674-0785.2020.01.013

所属专题: 文献

综述

抗肾小球基底膜抗体病的诊断、预后影响因素及治疗的研究进展
钟慧明1, 伍刚1,(), 朱志永2, 杨敏1, 李佳美1   
  1. 1. 225000 扬州,扬州大学临床医学院 苏北人民医院肾脏内科
    2. 255036 淄博市中心医院肾脏内科
  • 收稿日期:2019-09-17 出版日期:2020-01-15
  • 通信作者: 伍刚

Progress in diagnosis, prognostic evaluation, and treatment of anti-glomerular basement membrane antibody disease

Huiming Zhong1, Gang Wu1,(), Zhiyong Zhu2, Min Yang1, Jiamei Li1   

  1. 1. Department of Nephrology, Subei Renmin Hospital, the Clinical Medical College of Yangzhou University, Yangzhou 225000, China
    2. Department of Nephrology, Zibo Central Hospital, Zibo 255036, China
  • Received:2019-09-17 Published:2020-01-15
  • Corresponding author: Gang Wu
  • About author:
    Corresponding author: Wu Gang, Email:
引用本文:

钟慧明, 伍刚, 朱志永, 杨敏, 李佳美. 抗肾小球基底膜抗体病的诊断、预后影响因素及治疗的研究进展[J]. 中华临床医师杂志(电子版), 2020, 14(01): 62-67.

Huiming Zhong, Gang Wu, Zhiyong Zhu, Min Yang, Jiamei Li. Progress in diagnosis, prognostic evaluation, and treatment of anti-glomerular basement membrane antibody disease[J]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(01): 62-67.

抗肾小球基底膜(GBM)抗体病是一种以抗GBM抗体沉积于肾脏或肺泡基底膜为特点的自身免疫性血管炎疾病。典型临床表现为肾功能急剧衰竭伴或不伴弥漫性肺泡出血。其主要诊断依据为血清或组织中检测出抗GBM抗体。该病起病急,进展快,预后差,死亡率高,多数未经治疗的患者在疾病早期即进展为终末期肾脏病(ESRD)。少尿、年龄>60岁、诊断时血肌酐>500 μmol/L、新月体百分数>75%、抗中性粒细胞胞质抗体(ANCA)阳性等多种因素均与患者及肾脏预后不良相关。尽早采用血浆置换、糖皮质激素及环磷酰胺联合治疗可显著改善预后。早诊断及明确影响患者和肾脏预后的相关因素有助于制定有效的治疗方案,这对控制抗GBM抗体病发展的意义重大。

Anti-glomerular basement membrane (GBM) antibody disease is an autoimmune vasculitis characterized by the deposition of anti-GBM antibody in the renal or alveolar basement membrane. The typical clinical presentation of this disease is acute renal failure with or without diffuse alveolar hemorrhage. Central to the diagnosis of this disease is the detection of anti-GBM antibody, either in circulation or in tissues. It has a fast onset, rapid progression, poor prognosis, and high mortality, and most untreated patients progress early in the course of the disease to end stage renal disease (ESRD). Oliguria, age>60 years, serum creatinine>500 μmol/L at diagnosis, crescent>75%, positive anti-neutrophil cytoplasmic antibody (ANCA), and other factors are associated with a poor prognosis of the patients and kidneys. Combination therapy of plasma exchange, glucocorticoid, and cyclophosphamide can improve the prognosis if used earlier. Therefore, early diagnosing and identifying the relevant factors affecting the prognosis of the kidney and patients to develop an effective therapy is of great significance to control the development of the disease.

1
Canney M, O′Hara PV, McEvoy CM, et al. Spatial and temporal clustering of anti-glomerular basement membrane disease [J]. Clin J Am Soc Nephrol, 2016, 11(8): 1392-1399.
2
Ooi JD, Petersen J, Tan YH, et al. Dominant protection from HLA linked autoimmunity by antigen-specific regulatory T cells [J]. Nature, 2017, 545(7653): 243-247.
3
Henderson Scott R, Salama Alan D. Diagnostic and management challenges in Goodpasture′s (anti-glomerular basement membrane) disease [J]. Nephrol Dial Transplant, 2018, 33(2): 196-202.
4
Hellmark T, Segelmark M. Diagnosis and classification of Goodpasture′s disease (anti-GBM) [J]. J Autoimmunity, 2014, 48-49: 108-112.
5
李丽娟,李晓梅,曾彩虹. 114例抗肾小球基底膜抗体阳性结果分析 [J]. 检验医学与临床, 2018, 15(21): 3186-3190.
6
McAdoo SP, Pusey CD. Anti-glomerular basement membrane disease [J]. CJASN, 2017, 12(7): 1162-1172.
7
朱厚玲,邱红渝. 抗基底膜抗体肾炎伴抗中性粒细胞胞浆抗体阳性的新月体肾小球肾炎一例 [J]. 华西医学, 2017, 32(5): 795-796.
8
Serra G, Brun AL, Toledano D, et al. Thoracic involvement in systemic primary vasculitis: radiological patterns and follow-up [J]. JBR-BTR, 2014, 97(2): 57-68.
9
Ohlsson S, Herlitz H, Lundberg S, et al. Circulating anti-glomerular basement membrane antibodies with predominance of subclass IgG4 and falsenegative immunoassay test results in anti-glomerular basement membrane disease [J]. Am J Kidney Dis, 2014, 63: 289-293.
10
Segelmark M, Hellmark T. Anti-glomerular basement membrane disease: an update on subgroups, pathogenesis and therapies [J]. Nephrol Dial Transplant, 2019, 34: 1826-1832.
11
Nasr SH, Collins AB, Alexande MP, et al. The clinicopathologic characteristics and outcome of atypical anti-glomerular basement membrane nephritis [J]. Kidney Int, 2016, 89(4): 897-908.
12
Marques C, Carvelli J, Biard L, et al. Prognostic factors in anti-glomerular basement membrane disease: a multicenter study of 119 patients [J]. Front Immunol, 2019, 10: 1665.
13
Alchi B, Griffiths M, Sivalingam M, et al. Predictors of renal and patient outcomes in anti-GBM disease: Clinicopathologic analysis of a two-centre cohort [J]. Nephrol Dial Transplant, 2015, 30: 814-821.
14
McAdoo SP, Tanna A, Hrušková Z, et al. Patients double-seropositive for ANCA and anti-GBM antibodies have varied renal survival, frequency of relapse, and outcomes compared to single-seropositive patients [J]. Kidney Int, 2017, 92(3): 693-702.
15
Huart A, Josse AG, Chauveau D, et al. Outcomes of patients with Goodpasture syndrome: A nationwide cohort-based study from the French Society of Hemapheresis [J]. J Autoimmun, 2016, 73: 24-29.
16
Van Daalen EE, Jennette JC, McAdoo SP, et al. Predicting outcome in patients with anti-GBM glomerulonephritis [J]. Clin J Am Soc Nephrol, 2018, 13: 63-72.
17
Chen S, Tang Z, Xiang HY, et al. Etiology and outcome of crescentic glomerulonephritis from a single center in China: A 10-year review [J]. Am J Kidney Dis, 2016, 67(3): 376-383.
18
Liang D, Liang S, Xu F, et al. Clinicopathological features and outcome of antibody-negative anti-glomerular basement membrane disease [J]. J Clin Pathol, 2019, 72(1): 31-37.
19
Nasr SH, Collins AB, Alexander MP, et al. The clinicopathologic characteristics and outcome of atypical anti-glomerular basement membrane nephritis [J]. Kidney Int, 2016, 89: 897-908.
20
Nagano C, Goto Y, Kasahara K, et al. Case report: anti-glomerular basement membrane antibody disease with normal renal function [J]. BMC Nephrol, 2015, 16: 185.
21
Troxell ML, Houghton DC. Atypical anti-glomerular basement membrane disease [J]. ClinKidney J, 2016, 9, 211-221.
22
贾晓玉,刘丽萍,崔昭,等. 血浆置换治疗清除抗肾小球基底膜抗体的效率及其与肾脏预后的关系 [J].中国血液净化, 2018, 17(10): 672-676.
23
Biesenbach P, Kain R, Derfler K, et al. Long-term outcome of antiglomerular basement membrane antibody disease treated with immunoadsorption [J]. PLoS One, 2014, 9:e103568.
24
Winstedt L, Jarnum S, Nordahl EA, et al. Complete removal of extracellular IgG antibodies in a randomized dose-escalation phase I study with the bacterial enzyme IdeS-a novel therapeutic opportunity [J]. PLoS One, 2015, 10: e0132011.
25
TouzotM, Poisson J, Faguer S, et al. Rituximab in anti-GBM disease: a retrospective study of 8 patients [J]. J Autoimmun, 2015, 60: 74-79.
26
Heitz M, Carron PL, Clavarino G, et al. Use of rituximab as an induction therapy in anti-glomerular basement-membrane disease [J]. BMC Nephrology, 2018, 19(1): 241.
27
Xu DC, Wu JX, Mei CL, et al. Novel therapy for anti-glomerular basement membrane basement membrane disease with Ig A nephropathy: a case report [J]. Exp Ther Med, 2016, 11(5): 1889-1892.
28
Ma KW, Mcadoo SP, Tam FWK. Targeting the tyrosine kinase signalling pathways for treatment of immune-mediated glomerulonephritis: from bench to bedside and beyond [J]. Nephrol Dial Transplant, 2017, 32(suppl 1): 129-138.
29
祁青,何世君,唐炜,等. 雷公藤内酯醇LLDT-8在抗GBM抗体诱导小鼠肾炎中的疗效作用及对Fc受体介导淋巴细胞活化的调控机制 [J]. 中国药理学与毒理学杂志. 2016, (10): 1033-1034.
[1] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1061-1067.
[2] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[3] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[4] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[5] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[6] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[7] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[8] 袁媛, 赵良平, 刘智慧, 张丽萍, 谭丽梅, 閤梦琴. 子宫内膜癌组织中miR-25-3p、PTEN的表达及与病理参数的关系[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1016-1020.
[9] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[10] 陆志峰, 周佳佳, 梁舒. 虚拟现实技术在治疗弱视中的临床应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 891-895.
[11] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[12] 岳瑞雪, 孔令欣, 郝鑫, 杨进强, 韩猛, 崔国忠, 王建军, 张志生, 孔凡庭, 张维, 何文博, 李现桥, 周新平, 徐东宏, 胡崇珠. 乳腺癌HER2蛋白表达水平预测新辅助治疗疗效的真实世界研究[J]. 中华临床医师杂志(电子版), 2023, 17(07): 765-770.
[13] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
[14] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
[15] 符梅沙, 周玉华, 李慧, 薛春颜. 淋巴细胞免疫治疗对复发性流产患者外周血T淋巴细胞亚群分布与PD1/PD-L1表达的影响及意义[J]. 中华临床医师杂志(电子版), 2023, 17(06): 726-730.
阅读次数
全文


摘要