与ANCA相关的血管炎的诊断和治疗
Andreas Kronbichler1, Ingeborg M Bajema2, Annette Bruchfeld3
1Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria; Department of Medicine, University of Cambridge, Cambridge, UK.
Lancet (London, England)
|February 17, 2024
概括
抗中性细胞体抗体 (ANCA) 相关的血管炎,包括带有多炎和微观多炎的粒状血管炎,是一种严重的自身免疫性疾病. 现代治疗侧重于向生物药物和早期诊断,提高生存率,但强调长期治疗毒性.
科学领域:
- 关节病学
- 免疫学
- 内部医学
背景情况:
- 抗中性细胞体抗体 (ANCA) 相关的血管炎包括带有多炎和微观多炎的粒状血管炎,严重的自身免疫性疾病.
- 这些疾病包括瘤性血管炎,影响多个器官,包括脏,肺和皮肤.
- 病理性特征包括粒状炎症与多叶膜炎,在微观多叶膜炎中不存在.
研究的目的:
- 审查与ANCA相关的血管炎的发展管理.
- 从细胞毒药物转向有针对性的生物疗法.
- 解决依赖葡萄糖皮质激素和长期治疗毒性的持续挑战.
主要方法:
- 对ANCA相关血管炎管理的当前文献的综述.
- 分析21世纪的治疗趋势,包括生物药物和诊断进步.
- 检查疾病结果,重点是减少死亡率和长期发病率.
主要成果:
- 管理已经转向针对性的生物药物来诱导和维持缓解.
- 通过改进的ANCA检测提前诊断改善了患者的治疗结果和存活率.
- 专注于治疗慢性脏和心血管疾病等长期疾病.
结论:
- 现代ANCA相关血管炎的治疗优先考虑生物药物和早期诊断.
- 减少葡萄糖皮质激素毒性仍然是开发新治疗策略的关键目标.
- 长期患者的健康需要解决与血管炎相关的慢性并发症及其治疗.
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