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成人 IgA 血管炎:一种罕见但极具挑战性的疾病。

IgA Vasculitis in Adults: a Rare yet Challenging Disease.

机构信息

Center for Vasculitis Care and Research, Cleveland Clinic, 9500 Euclid Avenue/A50, Cleveland, OH, 44195, USA.

Director of Medical Kidney Pathology, Department of Anatomic Pathology, Cleveland Clinic, 9500 Euclid Ave/L25, Cleveland, OH, 44195, USA.

出版信息

Curr Rheumatol Rep. 2021 Jul 1;23(7):50. doi: 10.1007/s11926-021-01013-x.

Abstract

PURPOSE OF REVIEW

IgA vasculitis (IgAV) is a rare and poorly understood systemic vasculitis in adults. Its diagnosis and treatment remain a challenge. Herein, we review the clinical manifestations, diagnosis, management, and prognosis of IgAV in adults.

RECENT FINDINGS

The clinical course of IgAV in adults appears to be different from pediatric IgAV, especially due to its higher risk of evolving into end-stage renal disease. Rising awareness and interest in adult-onset IgA vasculitis has resulted in recent increasing number of publications on different treatment experiences. However, there is still controversy over the role of glucocorticoid (GC) and different immunosuppressive therapies such as cyclophosphamide, rituximab, and mychophenolate mofetil for more severe IgAV. Data regarding potential benefits of targeting the mucosal immune system, toll-like receptors, complements, and tyrosine kinase inhibitors in the treatment of IgA nephropathy are emerging. High quality evidence or guidelines in the treatment of severe IgAV are lacking and there is still a great need for controlled trials.

摘要

目的综述

IgA 血管炎(IgAV)是一种罕见且尚未被充分认识的成人系统性血管炎。其诊断和治疗仍然是一个挑战。本文综述了成人 IgAV 的临床表现、诊断、治疗和预后。

最近的发现

成人 IgAV 的临床过程似乎与儿科 IgAV 不同,尤其是由于其进展为终末期肾病的风险更高。人们对成人发病 IgA 血管炎的认识和兴趣不断提高,最近有关不同治疗经验的出版物数量不断增加。然而,对于更严重的 IgAV,糖皮质激素(GC)和不同免疫抑制剂如环磷酰胺、利妥昔单抗和吗替麦考酚酯的作用仍存在争议。关于靶向黏膜免疫系统、 toll 样受体、补体和酪氨酸激酶抑制剂在 IgA 肾病治疗中的潜在益处的数据正在出现。在治疗严重 IgAV 方面,高质量的证据或指南缺乏,仍需要进行对照试验。

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