摘要
感染相关肾小球肾炎(infection-related glomerulonephritis,IRGN)是感染后免疫介导的肾小球损伤。本文报告1例急性乙型肝炎病毒感染后免疫复合物介导的肾小球肾炎,经规范抗病毒及免疫抑制治疗后病情仍持续进展。鉴于患者补体终末通路激活指标可溶性补体膜攻击复合物(soluble complement membrane attack complex,sC5b-9)显著升高,予依库珠单抗靶向治疗,患者尿总蛋白/肌酐比值显著下降,低蛋白血症及血尿明显改善,sC5b-9水平降低。本病例提示,补体系统异常活化可能为部分IRGN持续活动的关键机制,对于常规治疗无效者,进行补体功能筛查并尝试靶向补体终末通路治疗可能是一种有效的挽救策略。
Infection-related glomerulonephritis(IRGN)is an immune-mediated glomerular injury triggered by infectious agents.This article reports a case of immune complex-mediated glomerulonephritis following acute hepatitis B virus infection,which continued to progress despite standard antiviral and immunosuppressive therapy.Given the significant elevation of soluble complement membrane attack complex(sC5b-9),an indicator of terminal complement pathway activation,the patient was treated with eculizumab.Following treatment,the patient's urine protein-to-creatinine ratio significantly decreased,hypoalbuminemia and hematuria markedly improved,and sC5b-9 levels declined.This case suggests that abnormal complement system activation may be a key mechanism driving disease persistence in some patients with IRGN.For those unresponsive to conventional therapy,complement function screening and targeted terminal complement pathway inhibition may represent an effective salvage strategy.
作者
刘进源
王丹
刘淑琴
陈文芳
陈崴
王欣
LIU Jinyuan;WANG Dan;LIU Shuqin;CHEN Wenfang;CHEN Wei;WANG Xin(Department of Nephrology,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)
出处
《协和医学杂志》
北大核心
2026年第2期389-395,共7页
Medical Journal of Peking Union Medical College Hospital
