IgA肾病治疗进展

Progress in the Treatment of IgA Nephropathy

摘要: IgA肾病(IgAN)是最常见肾小球疾病，现有治疗下，绝大多数患者病情呈慢性进行性发展，其中约1/3的患者在发病10年后进展到终末期肾脏疾病(ESRD)，亟需新疗法。近年来，随着对IgAN发病机制研究的不断深入，特别是在致病性IgA合成、补体激活等核心环节取得了突破性进展，多款新型治疗药物已陆续获批进入临床应用阶段。这其中既包含针对黏膜免疫的首款对因治疗药物(靶向释放制剂布地奈德)，也涵盖了靶向B细胞与浆细胞的药物，以及作用于补体通路的相关药物。从前期开展的临床试验结果来看，这些药物均能有效减少IgAN患者的蛋白尿水平，并对肾脏疾病的进展起到延缓作用。展望未来，以个性化、精准化为核心，结合多靶点联合的治疗模式，将有望进一步优化IgAN患者的治疗效果，改善其长期预后。

Abstract: Immunoglobulin A nephropathy (IgAN) is the most common glomerular disease. Under current treatments, the condition of the vast majority of patients progresses chronically and progressively. Approximately one-third of these patients develop end-stage renal disease (ESRD) 10 years after the onset of the disease, creating an urgent need for new therapeutic approaches. In recent years, with the deepening of research on the pathogenesis of IgAN—particularly breakthroughs in core links such as the synthesis of pathogenic IgA and complement activation—a number of novel therapeutic drugs have been successively approved for clinical application. These include the first etiological therapeutic drug targeting mucosal immunity (budesonide targeted-release formulation), as well as drugs targeting B cells and plasma cells, and those acting on the complement pathway. Results from preliminary clinical trials indicate that these drugs can effectively reduce proteinuria levels in IgAN patients and delay the progression of kidney disease. Looking ahead, a treatment model centered on personalization and precision, combined with multi-target combination therapy, is expected to further optimize the therapeutic effects for IgAN patients and improve their long-term prognosis.