ISSN 1006-298X      CN 32-1425/R

导航

肾脏病与透析肾移植杂志 ›› 2012, Vol. 21 ›› Issue (3): 277-281.

• 论文 • 上一篇    下一篇

抗中性粒细胞胞质抗体相关性血管炎的免疫治疗现状及进展

  

  • 出版日期:2012-06-28 发布日期:2012-06-25
  • 基金资助:

    国家自然科学基金资助项目(30971366 )

New advance of immunosuppressive therapy in ANCA-associated vasculitides

  • Online:2012-06-28 Published:2012-06-25

摘要:

摘要 随着大量针对抗中性粒细胞胞质抗体(anti-neutrophil cytoplasmic antibodies,ANCA)相关性血管炎(ANCA-associated systemic vasculitis,AASV)临床试验的开展,一些新的循证医学结果逐渐达成共识:(1)糖皮质激素和环磷酰胺仍是AASV诱导期最主要的治疗手段,静脉注射环磷酰胺较口服更好;(2)对早期轻症AASV,甲氨蝶呤可以替代环磷酰胺,重症患者可血浆置换;(3)利妥昔单抗(rituximab,美罗华)已被证明在诱导AASV缓解方面与环磷酰胺有同样效果,对复发病例更优,有望成为标准治疗药物;(4)维持期治疗可用硫唑嘌呤;(5)随着疾病机制的不断深入,“分子治疗”被寄予厚望。本文就近年来基于主要临床试验所取得的免疫治疗进展作一综述。

关键词: 关键词 , 抗中性粒细胞胞质抗体;系统性血管炎;免疫抑制剂

Abstract:

ABSTRACT  Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) comprises Wegener granulomatosis, microscopic polyangiitis, Churg– Strauss syndrome and renal-limited vasculitis. Some new point of views had drawn along with the progress of evidence-based medicine: Glucocorticoids and cyclophosphamide are still commonly used to induce remission in generalized disease, and intravenous cyclophosphamide is better than oral cyclophosphamide with less side effects. Plasma exchange could used in life-threatening AASV; Methotrexate as a less-toxic alternative to cyclophosphamide to induce remission in early systemic AASV. Furthermore, rituximab is equally as effective as cyclophosphamide for induction of remission in AASV and might become the standard of therapy in the near future. Low-dose steroids plus azathioprine could be used as maintenance therapy; Molecules that block these pathways that are essential in the pathogenesis of AASV have shown benefit in animal models, providing hope for less-toxic therapies。This review highlights novel view of treatment of these diseases based several clinical trials.

Key words: Keywords , systemic vasculitis , antineutrophil cytoplasmic antibody , immunosuppressive agents