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中华肾病研究电子杂志 ›› 2022, Vol. 11 ›› Issue (01) : 33 -38. doi: 10.3877/cma.j.issn.2095-3216.2022.01.006

综述

抗中性粒细胞胞浆抗体相关性血管炎治疗研究进展
王鑫1, 刘维萍1,()   
  1. 1. 066000 河北医科大学附属秦皇岛市第一医院肾内科
  • 收稿日期:2021-04-21 出版日期:2022-02-28
  • 通信作者: 刘维萍

Advances in the treatment of antineutrophil cytoplasmic antibody-associated vasculitis

Xin Wang1, Weiping Liu1,()   

  1. 1. Department of Nephrology, Qinhuangdao First Hospital Affiliated to Hebei Medical University, Qinhuangdao 066000, Hebei Province, China
  • Received:2021-04-21 Published:2022-02-28
  • Corresponding author: Weiping Liu
引用本文:

王鑫, 刘维萍. 抗中性粒细胞胞浆抗体相关性血管炎治疗研究进展[J]. 中华肾病研究电子杂志, 2022, 11(01): 33-38.

Xin Wang, Weiping Liu. Advances in the treatment of antineutrophil cytoplasmic antibody-associated vasculitis[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2022, 11(01): 33-38.

抗中性粒细胞胞浆抗体相关性血管炎(AAV)是一种以中小血管坏死性血管炎为特征的危及生命的自身免疫性疾病。目前采用的治疗策略为大剂量糖皮质激素联合免疫抑制剂环磷酰胺或利妥昔单抗。总缓解率为70%~90%,但复发率很高,且激素引起的治疗相关副作用决定死亡率和长期生活质量。预防复发,同时减少不良事件的发生是AAV治疗的主要目标。最新研究表明阻断缓激肽B1受体及抑制脾酪氨酸激酶对AAV的治疗结果可能产生重大影响。本文综述了AAV的最新研究进展,为降低AAV的复发率和死亡率、提高患者生活质量探讨新的治疗手段。

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a life-threatening autoimmune disease characterized by necrotizing vasculitis of small and medium vessels. The current treatment strategy is high-dose glucocorticoid combined with immunosuppressant cyclophosphamide or rituximab, with a total remission rate of 70%-90%. However, the relapse rate after treatment is high, and the toxicity associated with glucocorticoid still determines the mortality rate and long-term quality of life. The main goal of AAV treatment is to prevent recurrence and minimize the occurrence of adverse events. Recent studies suggest that blockade of the bradykinin B1 receptor and inhibition of spleen tyrosine kinase may have a significant impact on the therapeutic outcome of AAV. This article reviewed the the latest research progress in the treatment of AAV to explore new treatment methods for reducing the recurrence and mortality rate of AAV and improving the quality of life of the patients.

表1 2020年KDIGO血管炎治疗指南:免疫抑制剂的药物剂量
表2 2020年KDIGO血管炎治疗指南:免疫抑制剂维持期治疗剂量与疗程
图1 ANCA相关性血管炎治疗流程图注:AAV:抗中性粒细胞胞浆相关性血管炎;GC:糖皮质激素;CYC:环磷酰胺;RTX:利妥昔单抗;MMF:吗替麦考酚酯;AZA:硫唑嘌呤;GFR:肾小球滤过率;MTX:甲氨蝶呤
图2 ANCA相关性血管炎创新治疗作用位点注:Th2细胞:辅助型T细胞2;IL:白介素;TNF-α:肿瘤坏死因子α;HMGB-1:high mobility group box-1,高迁移率族蛋白B1;C5a:补体5a;Syk:脾酪氨酸激酶;NETs:中性粒细胞胞外诱捕网;ANCA:抗中性粒细胞胞浆抗体;B1R:缓激肽B1受体;Mac-1:巨噬细胞1抗原;LFA-1:淋巴细胞功能相关抗原-1,Fc:免疫球蛋白Fc段;FcγR:IgG Fc段受体
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