儿童狼疮性肾炎分型及治疗策略

doi:10.12372/jcp.2023.23e0916

临床儿科杂志 ›› 2023, Vol. 41 ›› Issue (12): 887-894.doi: 10.12372/jcp.2023.23e0916

儿童狼疮性肾炎分型及治疗策略

高春林

东部战区总医院儿科南京大学医学院附属金陵医院（东部战区总医院）儿科南京医科大学附属金陵医院儿科南方医科大学第一临床医学院附属金陵医院儿科（江苏南京 210002）

收稿日期:2023-09-18 出版日期:2023-12-15 发布日期:2023-12-04
作者简介:高春林，女，硕士生导师，儿科学博士，博士后，长期从事儿科肾脏病临床、教学、科研工作，对儿童肾病综合征、狼疮性肾炎、紫癜性肾炎、IgA 肾病、遗尿症、遗传性肾脏病等擅长。已发表 SCI 论文 30 余篇，核心期刊论文 30 余篇；主持国家自然科学基金 1 项，参与省部级课题 2项；获教育部自然科学奖二等奖 1次，江苏省医学科技奖二等奖 1项，军队医疗成果二等奖 1次，江苏省新技术引进奖 4 项；江苏省第六期“333 高层次人才”培养对象；参编专著 6本，专利 4 项。担任中华医学会儿科学分会儿肾学组委员、江苏省医学会儿科学分会副主委、江苏省医学会儿肾学组副组长、江苏省医师协会儿科分会委员，任临床儿科杂志、中华儿科杂志、药学与临床研究杂志编委。ORCID：0000-0001-8113-311X
基金资助:
东部战区总医院临床研究专项(22LCYY-XH9)

Renal pathologic classification and treatment strategy in children with lupus nephritis

GAO Chunlin

Department of Pediatrics, Jinling Hospital; Department of Pediatrics, Jinling Hospital, Medical School of Nanjing University; Department of Pediatrics, Jinling Hospital, Nanjing Medical University; Department of Pediatrics, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, Jiangsu, China

Received:2023-09-18 Published:2023-12-15 Online:2023-12-04

摘要/Abstract

摘要：

儿童狼疮性肾炎（LN）是儿童最常见的肾小球疾病，起病及病情进展均较成人严重，预后较其他肾小球疾病差，影响终生，病因未完全阐明。文章根据最新的国际指南，对儿童LN的病理分型及其相应治疗进行阐述。LN诊断根据2019年EULAR/ACR 系统性红斑狼疮分类标准，肾活检病理是目前的诊断的重要手段，增殖型和非增殖型LN治疗分为初始及维持治疗，参照成人指南推荐，合理和积极的治疗对于诱导疾病缓解和避免复发、改善预后非常重要。

关键词: 系统性红斑狼疮, 狼疮性肾炎, 治疗, 儿童

Abstract:

Lupus nephritis (LN) is the most common glomerular disease in children, with a more severe onset and progression compared to adults. The prognosis of LN in children is worse than other glomerular diseases and has lifelong effects, although the etiology remains unclear. This article provides an overview of the current diagnosis and treatment status of LN in children, along with a brief description of the treatment for each type of LN based on the latest international guidelines. LN was diagnosed according to the 2019 EULAR/ACR classification criteria for systemic lupus erythematosus. Renal biopsy pathology is an important diagnostic method at present. Treatment for proliferative and non-proliferative LN includes initial therapy and maintenance therapy, following recommendations from adult guidelines. Rational and proactive treatment is crucial for inducing disease remission, preventing relapse, and improving prognosis.

Key words: systemic lupus erythematosus, lupus nephritis, treatment, child

高春林. 儿童狼疮性肾炎分型及治疗策略[J]. 临床儿科杂志, 2023, 41(12): 887-894.

GAO Chunlin. Renal pathologic classification and treatment strategy in children with lupus nephritis[J]. Journal of Clinical Pediatrics, 2023, 41(12): 887-894.

图/表 1

参考文献 42

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治疗	方案	LN Ⅰ、Ⅱ型	LN Ⅲ、Ⅳ（±Ⅴ）型	LN Ⅴ型
初始治疗	常用方案	①非肾病范围蛋白尿：肾外表现来决定免疫抑制剂 ②肾病范围蛋白尿：GC ③镜下血尿：不需要针对肾病治疗 ④足细胞病：GC	①GC+MPAA ②GC+CTX ③GC+贝利尤单抗+MPAA或低剂量CTX ④GC+MPAA+CNIs	①非肾病范围蛋白尿：肾外表现来决定免疫抑制剂 ②肾病范围蛋白尿：GC+MPAA或GC+CTX（<6个月）或GC+CNIs或GC+利妥昔单抗（RTX）或GC+AZA
初始治疗	替代方案		GC+AZA GC+来氟米特
维持治疗		MPAA/AZA/贝利尤单抗
基础治疗	羟氯喹

儿童狼疮性肾炎分型及治疗策略

Renal pathologic classification and treatment strategy in children with lupus nephritis

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