原发性膜性肾病的诊治进展

Advances in the Diagnosis and Treatment of Primary Membranous Nephropathy

摘要: 原发性膜性肾病(PMN)是成人肾病综合征的主要病因，其病理特征为肾小球基底膜(GBM)上皮下免疫复合物沉积及GBM弥漫性增厚。近年来，随着足细胞特异性抗原及其自身抗体(如PLA2R、THSD7A)的相继鉴定，PMN的诊疗模式发生了从“经验性”向“精准化”的范式转变。本文综述了PMN的发病机制、遗传与环境诱因、诊断策略及治疗进展。目前，血清学检测已使非侵入性诊断及临床监测成为可能，但在复杂病例中肾活检仍具不可替代的地位。在治疗方面，虽然利妥昔单抗为主的生物制剂在安全性和有效性上展现出显著优势，但传统烷化剂方案在重症或高进展风险患者中依然占据核心地位。本文通过辩证分析现有诊疗手段的优势与局限，旨在为个体化治疗策略的制定提供参考，并指出新型靶点与联合用药方案是未来的发展方向。

Abstract: Primary membranous nephropathy (PMN) is the main cause of nephrotic syndrome in adults, its pathological features include the deposition of immune complexes beneath the glomerular basement membrane (GBM) and diffuse thickening of the GBM. In recent years, with the successive identification of podocyte-specific antigens and their autoantibodies (such as PLA2R and THSD7A). The diagnostic and treatment approach for PMN has undergone a paradigm shift from an “empirical” to a “precision-based” model. This article provides an overview of the pathogenesis, genetic and environmental factors, diagnostic strategies and therapeutic advances in PMN. At present, serological testing has made non-invasive diagnosis and clinical monitoring possible; However, in complex cases, renal biopsy remains indispensable. As regards treatment, although Rituximab-based biologics have demonstrated significant advantages in terms of safety and efficacy; however, traditional alkylating agent regimens remain the mainstay of treatment for patients with severe disease or at high risk of progression. This paper provides a dialectical analysis of the strengths and limitations of existing diagnostic and therapeutic methods, with the aim of providing guidance for the development of personalised treatment strategies. It also noted that novel targets and combination therapy regimens represent the future direction of development.