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摘要: IgA肾病(IgAN)是常见的原发性肾小球肾炎之一,也是导致终末期肾病的重要危险因素。肾移植是IgAN导致的终末期肾病患者的首选治疗方式,但肾移植术后仍存在IgAN复发风险。目前有关肾移植术后IgAN复发的相关研究进展缓慢。IgAN复发的发病机制尚未明确,其病理表现不具备特异性,确诊仍依赖于肾活组织检查,且尚未见有效的复发性IgAN防治方案。本文主要从肾移植术后IgAN复发的发病机制、诊断、危险因素及治疗手段等方面介绍肾移植术后IgAN复发的最新进展,以期为临床肾移植术后IgAN复发的防治提供参考,改善肾移植受者的预后。
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关键词:
- 肾移植 /
- IgA肾病(IgAN) /
- 终末期肾病 /
- 复发 /
- 半乳糖缺陷型IgA1(Gd-IgA1) /
- 蛋白尿 /
- 糖皮质激素 /
- 免疫抑制药
Abstract: IgA nephropathy (IgAN) is one of the common primary glomerulonephritis, which is also an important risk factor for end-stage renal disease. Kidney transplantation is the optimal treatment for end-stage renal disease induced by IgAN, whereas there is still a risk of recurrence of IgAN after kidney transplantation. At present, research progress upon IgAN recurrence after kidney transplantation is relatively lacking. The pathogenesis of IgAN recurrence remains elusive, and its pathological manifestations are not specific. The diagnosis of IgAN recurrence still depends on renal biopsy. Besides, no effective prevention and treatment are available for recurrent IgAN. In this article, research progress on IgAN recurrence after kidney transplantation was illustrated from the perspectives of pathogenesis, diagnosis, risk factors and treatment, aiming to provide reference for clinical prevention and treatment of IgAN recurrence after kidney transplantation and improve clinical prognosis of kidney transplant recipients. -
表 1 IgAN牛津病理分型[28]
Table 1. Oxford pathological classification of IgAN
病理特征 定义 评分 M 肾小球系膜区有≥4个系膜细胞 M0:≤50%系膜区细胞增多
M1: > 50%系膜区细胞增多E 肾小球毛细血管内细胞增多 E0:无
E1:有S 不涉及整个肾小球的粘连或硬化 S0:无
S1:有T 皮质区小管萎缩与间质纤维化的比例 T0:≤25%
T1:26%~50%
T2: > 50%C 细胞和(或)成纤维细胞新月体的比例 C0:无
C1: < 25%
C2:≥25% -
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