大血管性血管炎的新治疗策略
New Therapeutic Approaches to Large-Vessel Vasculitis
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影响因子:22.1
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
DOI:
10.1146/annurev-med-060622-100940
摘要
巨细胞动脉炎（GCA）和Takayasu动脉炎（TAK）是影响主动脉及其分支的大血管血管炎。这些疾病引起的动脉损伤可能导致缺血并发症、动脉瘤和夹层。尽管两者具有相似性，但GCA与TAK的治疗策略不同。糖皮质激素常用，但复发率高，且糖皮质激素的毒性带来显著的发病率。传统免疫抑制疗法在TAK中可能有效，然而在GCA中的作用尚不明确。肿瘤坏死因子抑制剂可改善缓解率，并似乎限制TAK的血管损伤，但对GCA无益。Tocilizumab是首个获批用于GCA的生物制剂类糖皮质激素替代药物，在TAK中也表现出一定疗效。对这两种疾病发病机制的深入理解及靶向治疗的开发，为未来治疗带来了巨大希望。
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.