摘要
原发性膜性肾病(primary membranous nephropathy,PMN)是成人肾病综合征的重要病因之一。抗磷脂酶A2受体(phospholipase A2 receptor,PLA2R)抗体的发现,推动PMN诊断与疗效监测进入生物标志物时代。PMN免疫抑制治疗的关键在于根据蛋白尿负荷、肾功能及抗PLA2R抗体滴度动态变化进行风险分层,从而个体化把握治疗启动时机,并以免疫学缓解与临床缓解作为双重治疗目标。本文结合循证证据与临床实践,系统阐述PMN免疫抑制治疗的启动时机、一线治疗方案(包括环磷酰胺联合糖皮质激素、钙调磷酸酶抑制剂及抗CD20单抗等),以及随访与复发管理要点,以期为临床个体化决策提供参考。
Primary membranous nephropathy(PMN)is a leading cause of nephrotic syndrome in adults.The discovery of antibodies against phospholipase A2 receptor(PLA2R)has ushered in the era of biomarkerbased diagnosis and therapeutic monitoring for PMN.The cornerstone of immunosuppressive therapy lies in risk stratification based on proteinuria levels,renal function,and dynamic changes in anti-PLA2R antibody titers,enabling individualized timing of treatment initiation with the dual goals of achieving both immunological and clinical remission.This article systematically reviews the initiation timing,first-line therapeutic options—including cyclophosphamide combined with corticosteroids,calcineurin inhibitors,and anti-CD20 monoclonal antibodies—and key considerations for follow-up and relapse management in PMN,integrating evidence-based findings with clinical practice to inform individualized decision-making.
作者
李超
李学旺
LI Chao;LI Xuewang(Department of Nephrology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)
出处
《协和医学杂志》
北大核心
2026年第2期301-309,共9页
Medical Journal of Peking Union Medical College Hospital
