IgA肾病诊疗范式演变:从传统风险分层到生物标志物驱动的精准医学OA
Evolving Paradigms in IgA Nephropathy Management:from Traditional Risk Stratification to Biomarker-Driven Precision Medicine
IgA肾病(IgA nephropathy,IgAN)是全球最常见的原发性肾小球肾炎,也是导致慢性肾脏病及肾衰竭的重要原因.IgAN在临床表现及组织病理方面均呈现显著异质性,使得不同患者的治疗反应及预后存在较大差异.因此,针对IgAN患者的精准风险评估及个体化干预意义重大.本文系统梳理IgAN诊疗模式从传统风险分层向生物标志物驱动的精准医学演变的研究进展.在回顾常用风险分层工具临床价值及其局限性的基础上,重点介绍与发病机制密切相关的新兴生物标志物,包括半乳糖缺乏型IgA1(galactose-deficient IgA1,Gd-IgA1)、抗Gd-IgA1 自身抗体、B细胞活化因子(B cell activating factor,BAFF)、增殖诱导配体(a proliferation-inducing ligand,APRIL)信号分子及补体成分等,以及由此催生的靶向治疗策略.此外,尿液生物标志物及多组学分析在疾病动态监测与个体化风险分层方面亦展现出重要应用前景.
IgA nephropathy(IgAN)is the most common primary glomerulonephritis worldwide and a major cause of chronic kidney disease and kidney failure.IgAN exhibits marked heterogeneity in clinical presen-tation,histopathology,and pathogenic mechanisms,contributing to variable treatment responses and prognosis among patients.Precise risk assessment and individualized intervention are therefore of critical importance.This review systematically traces the evolution of IgAN management from traditional risk stratification toward biomar-ker-driven precision medicine.We first review the clinical utility and limitations of established risk stratification tools,including the KDIGO guidelines,the Oxford MEST-C classification,and the International IgAN Predic-tion Tool.We then discuss emerging biomarkers closely linked to disease pathogenesis,including galactose-defi-cient IgA1(Gd-IgA1),anti-Gd-IgA1 autoantibodies,B cell activating factor(BAFF),a proliferation-inducing ligand(APRIL),and complement components,as well as the targeted therapies they have informed.In addi-tion,urinary biomarkers and multi-omics approaches show promise for dynamic disease monitoring and individu-alized risk stratification.
王丁丁;姚萌;柳潇;翟庆娴;文琼;陈崴
中山大学附属第一医院肾内科,广州 510080||国家卫生健康委员会肾脏病临床研究重点实验室(中山大学),广东省肾脏病重点实验室,广州 510080中山大学附属第一医院肾内科,广州 510080||国家卫生健康委员会肾脏病临床研究重点实验室(中山大学),广东省肾脏病重点实验室,广州 510080中山大学附属第一医院肾内科,广州 510080||国家卫生健康委员会肾脏病临床研究重点实验室(中山大学),广东省肾脏病重点实验室,广州 510080中山大学附属第一医院肾内科,广州 510080||国家卫生健康委员会肾脏病临床研究重点实验室(中山大学),广东省肾脏病重点实验室,广州 510080中山大学附属第一医院肾内科,广州 510080||国家卫生健康委员会肾脏病临床研究重点实验室(中山大学),广东省肾脏病重点实验室,广州 510080中山大学附属第一医院肾内科,广州 510080||国家卫生健康委员会肾脏病临床研究重点实验室(中山大学),广东省肾脏病重点实验室,广州 510080
医药卫生
IgA肾病精准医学风险分层生物标志物靶向治疗
IgA nephropathyprecision medicinerisk stratificationbiomarkerstargeted therapy
《协和医学杂志》 2026 (2)
317-323,7
国家重点研发计划(2025YFC2511800)国家自然科学基金(82370707,82570915)四大慢病重大专项(2023ZD0509300)广东省基础与应用基础研究重大项目(基石项目)(2023B0303000013)广州科技局农业和社会发展科技专题重点研发计划(2024B03J1337) National Key Research and Development Program of China(2025YFC2511800)National Natural Science Foun-dation of China(82370707,82570915)Major Project-Research on Cancer,Cardiovascular,Respiratory and Metabolic Diseases(2023ZD0509300)Guangdong Major Project of Guangdong Basic and Applied Basic Research(2023B0303000013)Guangzhou Technology Program of Agriculture and Social Development of Key Research and Development Scheme(2024B03J1337)
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