Neumann Thomas
Klinik für Rheumatologie, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Schweiz.
Universität Zürich, Rämistrasse 71, 8006, Zürich, Schweiz.
Z Rheumatol. 2022 May;81(4):305-312. doi: 10.1007/s00393-022-01162-z. Epub 2022 Mar 18.
Immunoglobulin A vasculitis (IgAV) is a systemic vasculitis of the small vessels with formation of IgA immune complexes and a broad spectrum of clinical constellations. Typical manifestations include purpura, arthralgia or arthritis, enteritis and glomerulonephritis. The IgAV is the most common vasculitis in childhood with a mostly uncomplicated and self-limiting course. In adults IgAV is much less frequent but the course can be more complicated, especially with renal or gastrointestinal manifestations. Various triggers of IgAV including infections have been described, whereby impaired glycosylation of IgA1 with subsequent exposure of binding sites for autoantibodies is a pathophysiological precondition for the vasculitis. Therapeutic strategies with immunosuppressants are so far supported by low evidence, take the severity of the organ manifestations into account and are oriented towards the recommendations for the treatment of other vasculitides of small vessels. Benign courses are treated symptomatically. The long-term prognosis of IgAV is determined by the renal manifestation.
免疫球蛋白A血管炎(IgAV)是一种小血管系统性血管炎,伴有IgA免疫复合物形成及广泛的临床症状群。典型表现包括紫癜、关节痛或关节炎、肠炎和肾小球肾炎。IgAV是儿童期最常见的血管炎,病程大多不复杂且为自限性。在成人中,IgAV的发病率要低得多,但病程可能更复杂,尤其是出现肾脏或胃肠道表现时。已描述了包括感染在内的IgAV的各种触发因素,其中IgA1糖基化受损,随后自身抗体结合位点暴露,是血管炎的病理生理前提。迄今为止,免疫抑制剂治疗策略的证据不足,需考虑器官表现的严重程度,并参照其他小血管血管炎的治疗建议。症状较轻的病程采取对症治疗。IgAV的长期预后由肾脏表现决定。