IgA肾病的研究进展
Research Progress in IgA Nephropathy
DOI: 10.12677/tcm.2025.1411728, PDF,    科研立项经费支持
作者: 黄玉莲, 朱 凯：成都中医药大学临床医学院，四川 成都；何玉华：成都中医药大学附属医院肾病科，四川 成都
关键词: IgA肾病；发病机制；西医治疗；中医病机；中医治疗；IgA Nephropathy； Pathogenesis； Western Medicine Treatment； Traditional Chinese Medicine (TCM) Etiology and Pathogenesis； Traditional Chinese Medicine (TCM) Treatment
摘要: IgA肾病是世界最常见的原发性肾小球疾病之一，也是导致终末期肾病的重要原因。本文围绕IgA肾病的西医发病机制与治疗措施、中医病因病机、辨证论治体系以及中医治疗进行综述，以期为临床实践提供参考。
Abstract: IgA nephropathy is one of the most common primary glomerular diseases worldwide and a significant cause of end-stage renal disease. This article reviews the pathogenesis and treatment measures of IgA nephropathy from the perspective of Western medicine, as well as its etiology, pathogenesis, pattern differentiation system, and traditional Chinese medicine therapies, with the aim of providing a reference for clinical practice.
文章引用：黄玉莲, 朱凯, 何玉华. IgA肾病的研究进展[J]. 中医学, 2025, 14(11): 5042-5049. https://doi.org/10.12677/tcm.2025.1411728

参考文献

[1] Ghaddar, M., Canney, M. and Barbour, S.J. (2024) IgA Nephropathy: Epidemiology and Disease Risk across the World. Seminars in Nephrology, 44, 151564. [Google Scholar] [CrossRef] [PubMed]
[2] Pattrapornpisut, P., Avila-Casado, C. and Reich, H.N. (2021) IgA Nephropathy: Core Curriculum 2021. American Journal of Kidney Diseases, 78, 429-441. [Google Scholar] [CrossRef] [PubMed]
[3] Suzuki, H., Kiryluk, K., Novak, J., Moldoveanu, Z., Herr, A.B., Renfrow, M.B., et al. (2011) The Pathophysiology of IgA Nephropathy. Journal of the American Society of Nephrology, 22, 1795-1803. [Google Scholar] [CrossRef] [PubMed]
[4] Jandhyala, S.M. (2015) Role of the Normal Gut Microbiota. World Journal of Gastroenterology, 21, 8787-8803. [Google Scholar] [CrossRef] [PubMed]
[5] Tan, J., Dong, L., Jiang, Z., Tan, L., Luo, X., Pei, G., et al. (2022) Probiotics Ameliorate IgA Nephropathy by Improving Gut Dysbiosis and Blunting NLRP3 Signaling. Journal of Translational Medicine, 20, Article No. 382. [Google Scholar] [CrossRef] [PubMed]
[6] Zhao, J., Bai, M., Ning, X., Qin, Y., Wang, Y., Yu, Z., et al. (2022) Expansion of Escherichia-Shigella in Gut Is Associated with the Onset and Response to Immunosuppressive Therapy of IgA Nephropathy. Journal of the American Society of Nephrology, 33, 2276-2292. [Google Scholar] [CrossRef] [PubMed]
[7] Zhong, Z., Tan, J., Tan, L., Tang, Y., Qiu, Z., Pei, G., et al. (2020) Modifications of Gut Microbiota Are Associated with the Severity of IgA Nephropathy in the Chinese Population. International Immunopharmacology, 89, Article ID: 107085. [Google Scholar] [CrossRef] [PubMed]
[8] Tang, Y., Zhu, Y., He, H., Peng, Y., Hu, P., Wu, J., et al. (2022) Gut Dysbiosis and Intestinal Barrier Dysfunction Promotes IgA Nephropathy by Increasing the Production of Gd-IgA1. Frontiers in Medicine, 9, Article 944027. [Google Scholar] [CrossRef] [PubMed]
[9] Sugurmar, A.N.K., Mohd, R., Shah, S.A., Neoh, H. and Cader, R.A. (2021) Gut Microbiota in Immunoglobulin a Nephropathy: A Malaysian Perspective. BMC Nephrology, 22, Article No. 145. [Google Scholar] [CrossRef] [PubMed]
[10] De Angelis, M., Montemurno, E., Piccolo, M., Vannini, L., Lauriero, G., Maranzano, V., et al. (2014) Microbiota and Metabolome Associated with Immunoglobulin a Nephropathy (IgAN). PLoS ONE, 9, e99006. [Google Scholar] [CrossRef] [PubMed]
[11] He, J., Zhou, X., Li, Y., Wang, Y., Liu, L., Shi, S., et al. (2021) Associations of Genetic Variants Contributing to Gut Microbiota Composition in Immunoglobin a Nephropathy. mSystems, 6, e00819-20. [Google Scholar] [CrossRef] [PubMed]
[12] Hu, X., Du, J., Xie, Y., Huang, Q., Xiao, Y., Chen, J., et al. (2020) Fecal Microbiota Characteristics of Chinese Patients with Primary IgA Nephropathy: A Cross-Sectional Study. BMC Nephrology, 21, Article No. 97. [Google Scholar] [CrossRef] [PubMed]
[13] Yao, K., Zheng, L., Chen, W., Xie, Y., Liao, C. and Zhou, T. (2025) Characteristics, Pathogenic and Therapeutic Role of Gut Microbiota in Immunoglobulin a Nephropathy. Frontiers in Immunology, 16, Article 1438683. [Google Scholar] [CrossRef] [PubMed]
[14] 曾赏, 周绪杰. IgA肾病的遗传学研究进展[J]. 实用医院临床杂志, 2024, 21(1): 13-18.
[15] Eknoyan, G., Lameire, N., Wolfgang, C.L., et al. (2024) KDIGO 2024 Clinical Practice Guideline for the Management of Immuno-Gobulin A Nepropathy (IgA) and Immunoglobulin A Vasculitis.
https://kdigo.org/igan-igav-public-review-draft/
[16] Ammirati, A.L. (2020) Chronic Kidney Disease. Revista da Associação Médica Brasileira, 66, s03-s09. [Google Scholar] [CrossRef] [PubMed]
[17] Zhang, B. and Deng, L. (2025) Application of SGLT-2 Inhibitors in Non-Diabetic CKD: Mechanisms, Efficacy, and Safety. Frontiers in Medicine, 12, Article 1574693. [Google Scholar] [CrossRef] [PubMed]
[18] Nuffield Department of Population Health Renal Studies Group and SGLT2 inhibitor Meta-Analysis Cardio-Renal Trialists’ Consortium (2022) Impact of Diabetes on the Effects of Sodium Glucose Co-Transporter-2 Inhibitors on Kidney Outcomes: Collaborative Meta-Analysis of Large Placebo-Controlled Trials. Lancet, 400, 1788-1801.
[19] Kohan, D.E. and Barton, M. (2014) Endothelin and Endothelin Antagonists in Chronic Kidney Disease. Kidney International, 86, 896-904. [Google Scholar] [CrossRef] [PubMed]
[20] Rovin, B.H., Barratt, J., Heerspink, H.J.L., Alpers, C.E., Bieler, S., Chae, D., et al. (2023) Efficacy and Safety of Sparsentan versus Irbesartan in Patients with IgA Nephropathy (PROTECT): 2-Year Results from a Randomised, Active-Controlled, Phase 3 Trial. The Lancet, 402, 2077-2090. [Google Scholar] [CrossRef] [PubMed]
[21] Syed, Y.Y. (2023) Sparsentan: First Approval. Drugs, 83, 563-568. [Google Scholar] [CrossRef] [PubMed]
[22] Heerspink, H.J.L., Jardine, M., Kohan, D.E., Lafayette, R.A., Levin, A., Liew, A., et al. (2025) Atrasentan in Patients with IgA Nephropathy. New England Journal of Medicine, 392, 544-554. [Google Scholar] [CrossRef] [PubMed]
[23] Keam, S.J. (2025) Atrasentan: First Approval. Drugs, 85, 1311-1317. [Google Scholar] [CrossRef] [PubMed]
[24] Locatelli, F., Del Vecchio, L. and Ponticelli, C. (2023) Systemic and Targeted Steroids for the Treatment of IgA Nephropathy. Clinical Kidney Journal, 16, ii40-ii46. [Google Scholar] [CrossRef] [PubMed]
[25] 王梦莹, 马坤岭. 糖皮质激素治疗原发性肾小球疾病的研究进展[J]. 东南大学学报(医学版), 2022, 41(5): 739-745.
[26] Yilei, L., Yating, D., Yaxuan, F., Chenxuan, L., Tingzhu, C., Jinpu, L., et al. (2025) Hydroxychloroquine Sulfate for IgA Nephropathy: Mechanisms and Therapeutic Potential in Improving Proteinuria and Alleviating Disease Progression—A Literature Review. BMC Nephrology, 26, Article No. 317. [Google Scholar] [CrossRef] [PubMed]
[27] 国文凯, 纪鹏程, 毕靖茹, 等. IgA肾病的十种治疗措施[J]. 中华肾病研究电子杂志, 2024, 13(6): 327-333.
[28] Feng, L., Song, X., Shi, X., Qin, M., Liang, N., Li, B., et al. (2024) Off-Label Use of Mycophenolate Mofetil in Immunoglobulin a Nephropathy: A Systematic Review and Meta-Analysis. American Journal of Nephrology, 56, 35-47. [Google Scholar] [CrossRef] [PubMed]
[29] Qi, F., Zeng, H. and Zhang, J. (2025) Targeted-Release Budesonide: A Comprehensive Review on Its Potential in IgA Nephropathy. Heliyon, 11, e42729. [Google Scholar] [CrossRef] [PubMed]
[30] Barratt, J., Barbour, S.J., Brenner, R.M., Cooper, K., Wei, X., Eren, N., et al. (2024) Long-Term Results from an Open-Label Extension Study of Atacicept for the Treatment of IgA Nephropathy. Journal of the American Society of Nephrology, 36, 679-687. [Google Scholar] [CrossRef] [PubMed]
[31] Zan, J., Liu, L., Li, G., Zheng, H., Chen, N., Wang, C., et al. (2024) Effect of Telitacicept on Circulating Gd-IgA1 and IgA-Containing Immune Complexes in IgA Nephropathy. Kidney International Reports, 9, 1067-1071. [Google Scholar] [CrossRef] [PubMed]
[32] Perkovic, V., Barratt, J., Rovin, B., Kashihara, N., Maes, B., Zhang, H., et al. (2025) Alternative Complement Pathway Inhibition with Iptacopan in IgA Nephropathy. New England Journal of Medicine, 392, 531-543. [Google Scholar] [CrossRef] [PubMed]
[33] 黄帝内经[M]. 北京: 人民卫生出版社, 2021.
[34] 吴昆. 医方考[M]. 洪青山, 校注. 北京: 中国中医药出版社, 1998: 145.
[35] 范永升. 金匮要略[M]. 北京: 中国中医药出版社, 2005: 147.
[36] 王肯堂. 证治准绳[M]. 北京: 中国中医药出版社, 2019: 256.
[37] 徐炎, 丁樱, 李东林, 等. 丁樱基于肾浊理论论治IgA肾病经验介绍[J]. 中国中医基础医学杂志, 2024, 30(2): 316-318.
[38] 张权, 陈以平, 张先闻, 等. 陈以平教授“斡旋三焦”法治疗IgA肾病的经验[J]. 中国医药导报, 2022, 19(23): 142-145, 161.
[39] 范高伟, 范军. 国医大师张大宁治疗IgA肾病经验[J]. 湖南中医杂志, 2019, 35(3): 36-38.
[40] 黄冰榆, 张喜奎. 张喜奎教授基于六经辨证论治IgA肾病经验[J]. 福建中医药, 2023, 54(7): 57-59.
[41] 王乐川, 肖卫灵, 樊佳鑫, 等. 大黄泄浊方对IgA肾病伴早期肾衰竭患者肾功能、微炎症水平的影响[J]. 河北中医药学报, 2025, 40(4): 12-17.
[42] 周华虹, 董艺, 傅晓骏. 芪蛭合剂联合替米沙坦片对气虚血瘀型IgA肾病临床疗效的影响[J]. 重庆医学, 2025, 54(9): 2018-2022, 2027.
[43] 吴松果, 李伟, 李娇艳. 小蓟饮子加减治疗IgA肾病血尿的远期肾脏终点事件分析[J/OL]. 中华中医药学刊: 1-12.
https://link.cnki.net/urlid/21.1546.r.20250627.1653.002, 2025-10-14.
[44] 姜衍, 张明, 刘国鑫, 等. 黄葵胶囊联合环磷酰胺及泼尼松治疗肾功能不全IgA肾病的临床观察[J]. 中国药房, 2025, 36(15): 1899-1903.
[45] 高小琴, 吕勇, 付甜甜, 等. 芪藤消浊颗粒对脾肾亏虚湿瘀证IgA肾病的临床干预作用[J]. 中医药临床杂志, 2025, 37(2): 345-348.