大型血管炎的新治疗方法
New Therapeutic Approaches to Large-Vessel Vasculitis
影响因子:22.10000
分区:医学1区 Top / 医学：研究与实验1区
发表日期:2024 Jan 29
作者:
Mahmut S Kaymakci, Kenneth J Warrington, Tanaz A Kermani
摘要
巨细胞动脉炎（GCA）和高山动脉炎（TAK）是影响主动脉及其分支的大老板血管。这些疾病的动脉损害可能导致缺血性并发症，动脉瘤和解剖。尽管它们相似，但GCA和TAK的管理仍有不同。糖皮质激素经常使用，但复发很常见，糖皮质激素毒性有助于显着发病。传统的免疫抑制疗法在TAK中可能是有益的，尽管它们在GCA管理中的作用尚不清楚。肿瘤坏死因子抑制剂提高了缓解率，并且似乎限制了TAK中的血管损伤；这些药物在GCA中无益。 Tocilizumab是批准用于GCA的第一个生物糖皮质激素剂，并且在TAK中似乎也很有效。更好地理解这两种情况的发病机理和目标疗法的可用性，对未来的管理有很大的希望。
Abstract
Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are large-vessel vasculitides affecting the aorta and its branches. Arterial damage from these diseases may result in ischemic complications, aneurysms, and dissections. Despite their similarities, the management of GCA and TAK differs. Glucocorticoids are used frequently but relapses are common, and glucocorticoid toxicity contributes to significant morbidity. Conventional immunosuppressive therapies can be beneficial in TAK, though their role in the management of GCA remains unclear. Tumor necrosis factor inhibitors improve remission rates and appear to limit vascular damage in TAK; these agents are not beneficial in GCA. Tocilizumab is the first biologic glucocorticoid-sparing agent approved for use in GCA and also appears to be effective in TAK. A better understanding of the pathogenesis of both conditions and the availability of targeted therapies hold much promise for future management.