Immunoglobulin A Nephropathy in China: Progress and Challenges
Immunoglobulin A Nephropathy in China: Progress and Challenges
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DOI：
10.1159/000225563
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发表时间：
2009-01-01
影响因子：
4.2
通讯作者：
Chen, Xiang-Mei
中科院分区：
文献类型：
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作者：
Cai, Guang-Yan;Chen, Xiang-Mei
背景：IgA肾病（IgAN）是中国最常见的原发性肾小球肾炎。约20%的患者会在10年内导致肾功能不全，即使在临床早期IgAN患者中也是如此，这给患者和社会造成了很大的负担。方法：回顾国内基础和临床研究工作。对来自中国和其他国家的数据进行了比较。结果：在中国患者中研究了IgAN易感性和疾病进展的遗传变异以及聚合IgA1的致病作用。中国IgAN伴镜下血尿、恶性高血压、月牙状肾小球肾炎、肾内动脉和肾小管间质病变的临床特征已被明确。临床试验表明，尿激酶+ ACEI或类固醇+ ACEI联合治疗在减少蛋白尿和保护肾功能方面比单独使用ACEI更有效。MMF在IgAN中的治疗作用仍有争议，尽管两项中国研究证明了其疗效。一些病例在服用MMF 3个月后可能发生严重的肺炎。结论：IgAN仍然是中国肾病专家面临的巨大挑战。未来需要深入的基础研究和多中心临床试验。版权所有(C) 2009 S. Karger AG，巴塞尔
Background: IgA nephropathy (IgAN) is the most common primary glomerulonephritis in China. In about 20% of patients it will lead to renal insufficiency within 10 years, even in those with clinically early IgAN, which causes a great burden for patients and society. Methods: We reviewed basic and clinical research work in China. Comparisons between data from China and those from other countries were made. Results: The genetic variations conferring susceptibility to IgAN and disease progression as well as the pathogenic role of polymeric IgA1 were investigated in Chinese patients. Clinical features of Chinese IgAN with isolated microscopic hematuria, malignant hypertension, crescentic glomerulonephritis, intrarenal arterial and tubulointerstitial lesions have been characterized. Clinical trials showed that the combined therapy with urokinase + ACEI, or steroid + ACEI was more effective than with ACEI alone in reducing proteinuria and protecting renal function. The therapeutic role of MMF in IgAN remains debated, although two Chinese studies demonstrated its efficacy. Severe pneumonia can possibly occur in some cases after MMF administration for 3 months. Conclusion: IgAN remains a great challenge to Chinese nephrologists. In-depth basic studies and multicenter clinical trials are needed in the future. Copyright (C) 2009 S. Karger AG, Basel