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抗中性粒细胞胞浆抗体相关肾小球肾炎的评估与治疗进展

Advances in the Assessment and Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Glomerulonephritis.

作者信息

Ni Anqi, Xu Ying, Chen Jianghua, Han Fei

机构信息

Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.

Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.

出版信息

J Inflamm Res. 2024 Dec 31;17:11881-11900. doi: 10.2147/JIR.S494848. eCollection 2024.

Abstract

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of autoimmune diseases primarily cause inflammation of small blood vessels. Renal involvement occurs frequently and often leads to end-stage renal disease (ESRD), which significantly impacts patient health and survival. Early diagnosis and appropriate treatment are essential to improving patient outcomes. This review provides an overview of the latest advances in the assessment and treatment of ANCA-associated glomerulonephritis (AAGN). The assessment section covers diagnostic tools, disease activity assessment, and risk stratification, with the introduction of the latest ANCA kidney risk score (AKRiS), which aids in identifying high-risk patients and facilitates personalized treatment strategies. The treatment section discusses induction and maintenance therapy, including immunosuppressive agents and emerging therapies. Recent advances have moved treatment away from reliance on cytotoxic agents, focusing on targeted biological therapies to induce and maintain disease remission, while prioritizing the reduction of corticosteroid toxicity. Overall, these advancements have greatly improved patient outcomes and provided new avenues for personalized management of AAGN.

摘要

抗中性粒细胞胞浆抗体(ANCA)相关血管炎(AAV)是一组主要引起小血管炎症的自身免疫性疾病。肾脏受累很常见,常导致终末期肾病(ESRD),这对患者的健康和生存有重大影响。早期诊断和适当治疗对于改善患者预后至关重要。本综述概述了ANCA相关肾小球肾炎(AAGN)评估和治疗的最新进展。评估部分涵盖诊断工具、疾病活动评估和风险分层,并介绍了最新的ANCA肾脏风险评分(AKRiS),该评分有助于识别高危患者并促进个性化治疗策略。治疗部分讨论诱导和维持治疗,包括免疫抑制剂和新兴疗法。最近的进展使治疗不再依赖细胞毒性药物,而是侧重于靶向生物疗法以诱导和维持疾病缓解,同时优先降低皮质类固醇毒性。总体而言,这些进展极大地改善了患者预后,并为AAGN的个性化管理提供了新途径。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8fc3/11725264/8374a18c2b17/JIR-17-11881-g0001.jpg

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