视神经脊髓炎谱系疾病的免疫治疗策略

doi:10.3969/j.issn.1006-9771.2018.08.021

摘要/Abstract

摘要： 在遵循循证医学基础上,结合疾病的发病机制及药物的作用机制,本文论述了近年来国内外针对视神经脊髓炎谱系疾病(NMOSD)的急性期治疗、预防复发治疗及潜在的免疫治疗。急性期治疗以抑制炎性应答,降低水通道蛋白4 (AQP4)抗体滴度为主,主要使用大剂量激素冲击疗法、血浆置换疗法。缓解期治疗以抑制T细胞、B细胞的增殖及去除体内B细胞为主,减少复发次数,主要给予硫唑嘌呤、利妥昔单抗及吗替麦考酚酯等。未来NMOSD的治疗将更趋于靶向性/特异性,其作用机制主要通过阻断致病性AOP4抗体与其抗原的结合,减少致病性AQP4抗体生成,阻断致病性抗体-抗原结合后的下游反应;主要包括aquaporumab、托珠单抗、DNA疫苗、抗CD₁₉单克隆抗体(MEDI-551)、艾库组单抗及贝伐单抗等。

关键词: 视神经脊髓炎谱系疾病, 水通道蛋白4, 免疫治疗

Abstract: This paper assembled immunotherapy methods for neuromyelitis optica spectrum disorder (NMOSD) in recent years, including the treatment of acute stage, the prevention of relapse and the potential immunotherapy. The treatment of acute stage is mainly to inhibit inflammatory response and reduce aquaporin 4 (AQP4) antibody(Ab) titer, and this is done mainly by using high-dose hormone shock therapy and plasmapheresis. Remission treatment is to inhibit the proliferation of T cells and B cells and also remove B cells from the body, for the purpose of reducing the number of relapses. Azathioprine, rituximab and mycophenolate mofetil are mainly given during remission stage. The treatment of NMOSD will become more targeted/specific in the future. The mechanism of action of the new drug is mainly through blocking the binding of pathogenic AQP4-Ab and its antigen (Ag), reducing the generation of pathogenic AQP4-Ab, and blocking the downstream reaction after pathogenic Ab-Ag binding. The new drugs mainly include aquaporumab, tocilizumab, DNA vaccine, anti-CD₁₉ monoclonal Ab (MEDI-551), eculizumab and bevacizumab.

Key words: neuromyelitis optica spectrum disorder, aquaporin 4, immunotherapy

中图分类号:

R744.5

方丽波, 刘广志, 薛迎红. 视神经脊髓炎谱系疾病的免疫治疗策略[J]. 《中国康复理论与实践》, 2018, 24(8): 987-992.

FANG Li-bo, LIU Guang-zhi, XUE Ying-hong. Immunotherapy Strategies for Neuromyelitis Optica Spectrum Disorder[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(8): 987-992.

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