原发性膜性肾病治疗新进展

doi:10.12114/j.issn.1007-9572.2025.0014

摘要/Abstract

摘要： 原发性膜性肾病（PMN）是一种肾脏特异性的自身免疫性疾病，是引起成年人肾病综合征最常见的疾病之一，其发病率逐年上升，有效的治疗能够显著的改善患者的预后。随着对膜性肾病发病机制的深入研究和新的特异性抗体的发现，PMN的治疗在近些年取得很大进展，越来越多的药物和方案尝试用于治疗PMN，提高了患者治疗疗效，本文对既往经典治疗方案进行回顾，着重分析利妥昔单抗对PMN的疗效及产生抵抗的原因，并对其他新型治疗方案也展开了讨论。

关键词: 膜性肾病, M型磷脂酶A2受体, 利妥昔单抗, 免疫抑制剂

Abstract:

Primary membranous nephropathy (PMN) is a kidney-specific autoimmune disease, which is one of the most common causes of nephrotic syndrome in adults, and its incidence is increasing year by year, and effective treatment can significantly improve the prognosis of patients. With the in-depth study of the pathogenesis of membranous nephropathy and the discovery of new specific antibodies, the treatment of PMN has made great progress in recent years, and more and more drugs and protocols have been attempted to be used in the treatment of PMN, which has improved the efficacy of patient treatment. This paper reviews the classic treatment options, focuses on the efficacy of rituximab on PMN and the reasons for resistance, and also discusses other novel treatment protocols.

Key words: Membranous nephropathy, M-type phospholipase A2 receptor 1, Rituximab, Immunosuppressant

中图分类号:

R 692.31

史国庆,张永哲,白瑜,等. 原发性膜性肾病治疗新进展[J]. 中国全科医学, 2026, 29(21): 3064-3072. DOI: 10.12114/j.issn.1007-9572.2025.0014.
SHI Guoqing,ZHANG Yongzhe,BAI Yu, et al. New Advances in the Treatment of Primary Membranous Nephropathy[J]. Chinese General Practice, 2026, 29(21): 3064-3072. DOI: 10.12114/j.issn.1007-9572.2025.0014.

图/表 1

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危险分层	分层依据
低风险	eGFR正常，尿蛋白< 3.5 g/d且血清白蛋白>30 g/L eGFR正常，尿蛋白<3.5 g/d，接受ACEI/ARB治疗后6个月尿蛋白下降≥50 %
中风险	eGFR正常，尿蛋白>3.5 g/d，接受ACEI/ARB治疗后6个月尿蛋白下降< 50%，并且其他指标未满足高风险标准
高风险	eGFR<60 mL·min·（1.73 m^2）-1和/或尿蛋白>8 g/d持续6个月以上 eGFR正常，尿蛋白>3.5 g/d，接受ACEI/ARB治疗后6个月尿蛋白下降<50%，并且满足下列至少1个条件：（1）血清白蛋白<25 g/L；（2）PLA2Rab>50 RU/mL；（3）尿α1微球蛋白>40 μg/min；（4）尿IgG>1 μg/min；（5）尿β2微球蛋白>250 mg/d；（6）选择性蛋白尿指数>0.20
极高风险	威胁生命的肾病综合征或肾功能快速进展

危险分层	分层依据
低风险	eGFR正常，尿蛋白< 3.5 g/d且血清白蛋白>30 g/L eGFR正常，尿蛋白<3.5 g/d，接受ACEI/ARB治疗后6个月尿蛋白下降≥50 %
中风险	eGFR正常，尿蛋白>3.5 g/d，接受ACEI/ARB治疗后6个月尿蛋白下降< 50%，并且其他指标未满足高风险标准
高风险	eGFR<60 mL·min·（1.73 m^2）-1和/或尿蛋白>8 g/d持续6个月以上 eGFR正常，尿蛋白>3.5 g/d，接受ACEI/ARB治疗后6个月尿蛋白下降<50%，并且满足下列至少1个条件：（1）血清白蛋白<25 g/L；（2）PLA2Rab>50 RU/mL；（3）尿α1微球蛋白>40 μg/min；（4）尿IgG>1 μg/min；（5）尿β2微球蛋白>250 mg/d；（6）选择性蛋白尿指数>0.20
极高风险	威胁生命的肾病综合征或肾功能快速进展