摘要
膜性肾病(MN)是一组以肾小球基底膜上皮细胞下免疫复合物沉积伴基底膜弥漫增厚为病理特征的疾病,其中70%~80%因病因不明被称为特发性膜性肾病(IMN)。近年来,随着抗M型磷脂酶A2受体(PLA2R)抗体、Ⅰ型血小板反应蛋白7A域(THSD7A)等自身抗体在IMN患者外周血中被发现,B淋巴细胞在IMN中的致病作用已逐渐引起重视。利妥昔单抗(RTX)是一种人/鼠嵌合型单抗,可耗竭CD20+B淋巴细胞,以减少自身抗体的产生。T淋巴细胞与B淋巴细胞在功能上相辅相成,IMN患者已被证实亦存在T淋巴细胞亚群数量和功能紊乱,故纠正T淋巴细胞亚群失衡可能是RTX发挥作用的另一重要机制。本文综述利妥昔单抗对IMN患者外周血T淋巴细胞的影响及其临床意义,以期为多靶点治疗IMN提供理论依据。
Membranous nephropathy(MN)is characterized by subepithelial immune complex deposition in the glomerular basement membrane and diffuse thickening of the basement membrane.Approximately 70%to 80%of these patients are termed idiopathic membranous nephropathy(IMN)due to the poorly defined pathogenesis.In recent years,the pathogenic role of B lymphocytes in MN has gained attention,as autoantibodies such as anti-phospholipase A2 receptor(PLA2R)antibodies and thrombospondin type-1 domain-containing 7A(THSD7A)have been identified in the peripheral blood of IMN patients.Rituximab(RTX),a human/mouse chimeric monoclonal antibody,can deplete CD20+B lymphocytes by reducing the production of autoantibodies.B lymphocytes and T lymphocytes complement each other in function.Studies have confirmed that IMN patients also have disorders in the number and function of T lymphocyte subpopulations.Therefore,RTX correction of T lymphocyte subpopulations imbalance may be another important mechanism for its effect.This article reviewed the impact of rituximab treatment on peripheral blood T lymphocytes in patients with IMN and its clinical significance,providing a theoretical basis for multi-target treatment of IMN.
作者
杨晶晶
沈蕾
YANG Jingjing;SHEN Lei(Department of Nephrology,the First Hospital Affiliated to Soochow University,Suzhou,Jiangsu,215000)
出处
《实用临床医药杂志》
CAS
2023年第10期134-138,共5页
Journal of Clinical Medicine in Practice
基金
江苏省老年健康科研课题(LKZ2023006)。
