Nephrology Unit, Saint Louis Hospital, INSERM 1149, CRI, 1 Av C. Vellefaux, 75010, Paris, France.
Department of Dermatology and Venereology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle/Saale, Germany.
Semin Immunopathol. 2021 Oct;43(5):729-738. doi: 10.1007/s00281-021-00874-9. Epub 2021 Jun 25.
IgA vasculitis (IgAV) is an inflammation of small vessels caused by perivascular deposition of IgA and activation of neutrophils. It may present as systemic vasculitis (IgAV - Henoch-Schönlein purpura) or as a variant restricted to the skin (skin-limited IgAV), while IgA nephropathy presents a variant restricted to the kidneys. Systemic IgAV affects children more frequently than adults (150 to 200 for 1; incidence 1 in 1 million/year). In the latter, disease more often leads to chronic renal disease. The dominant clinical features include round or oval and retiform palpable purpura predominantly on the lower legs, arthralgia or arthritis, gastrointestinal bleeding or pain and glomerulonephritis with mesangial IgA deposits (IgAVN). Pulmonary, cardiac, genital and neurological involvement occurs, but is rare. Immune complexes containing galactose-deficient IgA1 play a pivotal role in the pathophysiology of IgAV; via the Fc alpha receptor (CD89), they induce neutrophilic inflammation around cutaneous vessels and mesangial proliferation and inflammation in the glomerulus. In case of self-limited disease, only symptomatic treatment is recommended. Treatment of severe IgAV, nephritis or gastrointestinal manifestations, is not established, but some studies reported a benefit of corticosteroids, combined with immunosuppressive drugs. Short-term outcome depends on the severity of gastrointestinal manifestations, while long-term prognosis depends on the severity of nephritis.
IgA 血管炎(IgAV)是一种小血管炎症,由血管周围 IgA 沉积和中性粒细胞活化引起。它可能表现为系统性血管炎(IgAV - 亨诺克-舒恩莱因紫癜)或局限于皮肤的变异型(皮肤局限型 IgAV),而 IgA 肾病则表现为局限于肾脏的变异型。系统性 IgAV 比成人更常影响儿童(150 至 200 例/年;发病率为每 100 万人/年 1 例)。在后者中,疾病更常导致慢性肾脏病。主要的临床特征包括下肢主要出现圆形或椭圆形网状可触及紫癜、关节痛或关节炎、胃肠道出血或疼痛以及伴有系膜 IgA 沉积的肾小球肾炎(IgAVN)。肺、心脏、生殖器和神经系统受累也会发生,但较为罕见。含有半乳糖缺乏 IgA1 的免疫复合物在 IgAV 的病理生理学中起关键作用;通过 Fcα受体(CD89),它们在皮肤血管周围诱导中性粒细胞炎症,并在肾小球中诱导系膜增殖和炎症。对于自限性疾病,仅推荐对症治疗。严重 IgAV、肾炎或胃肠道表现的治疗尚未确定,但一些研究报告称皮质类固醇联合免疫抑制剂治疗有效。短期预后取决于胃肠道表现的严重程度,而长期预后取决于肾炎的严重程度。