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/OL]. 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/OL]. 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] 王亚红, 蔡胜, 葛志通, 杨筱, 李建初. 颅骨骨膜窦的超声表现一例[J/OL]. 中华医学超声杂志(电子版), 2024, 21(11): 1089-1091.
[2] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[3] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[4] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[5] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[6] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[7] 陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[8] 刘柏隆, 周祥福. 压力性尿失禁阶梯治疗的项目介绍[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 125-125.
[9] 刘柏隆. 女性压力性尿失禁阶梯治疗之手术治疗方案选择[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 126-126.
[10] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[11] 李浩, 陈棋帅, 费发珠, 张宁伟, 李元东, 王硕晨, 任宾. 慢性肝病肝纤维化无创诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 863-867.
[12] 谭瑞义. 小细胞骨肉瘤诊断及治疗研究现状与进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 781-784.
[13] 崔军威, 蔡华丽, 胡艺冰, 胡慧. 亚甲蓝联合金属定位夹及定位钩针标记在乳腺癌辅助化疗后评估腋窝转移淋巴结的临床应用价值探究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 625-632.
[14] 王誉英, 刘世伟, 王睿, 曾娅玲, 涂禧慧, 张蒲蓉. 老年乳腺癌新辅助治疗病理完全缓解的预测因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 641-646.
[15] 王子阳, 王宏宾, 刘晓旌. 血清标志物对甲胎蛋白阴性肝细胞癌诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 677-681.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?