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在开始使用瘤坏死因子α抑制剂之前,应该先查血清性质吗?

Srujan Edupuganti¹, Yashitha Chirumamilla², Manoj Upadhyay²

¹Department of Internal Medicine-Pediatrics, Hurley Medical Center, Flint, USA.

European journal of case reports in internal medicine

|May 8, 2024

概括

血清性质瘤可以模仿多炎 (GPA) 带来的颗粒性质瘤,并且与ANCA阳性有关. 免疫抑制疗法,特别是TNF-α抑制剂,需要仔细监测潜在的组织等离子体再激活,即使初始测试是负面的.

科学领域:

菌类学菌类学是指菌类学.
免疫学免疫学免疫学
传染性疾病传染性疾病

背景情况:

质体,一种二形真菌感染,在美国中西部和东南部流行,通常由颗粒瘤所包含.
由于免疫反应受损 (干扰素玛,TNF-α,介质蛋白-17) 的免疫功能受损的个体可以发生传播.
组织等离子体病的症状显著重叠于具有多炎 (GPA) 的粒状等离子体病.

研究的目的:

报告一例突出显示了基因质等离子体和抗中性粒细胞体抗体 (ANCA) 阳性之间的关联.
强调监测患者血清的重要性,特别是在启动TNF-α抑制剂后,尽管最初的感染性工作是负面的.
讨论当前关于在免疫抑制治疗前查基因质等离子体的指导方针.

主要方法:

一个48岁的女性出现了暗示GPA的症状的病例报告.
最初的调查对感染负面,但对ANCA阳性,导致GPA诊断和rituximab治疗.
重复的调查显示阳性 (1-3) -β-D-葡萄糖和尿液基质体抗原,促使抗真菌治疗.

主要成果:

患者在停止服用Rituximab并开始抗真菌治疗后,病情有所改善.
这一案例表明了基因质和ANCA阳性之间的联系.
负的传染病检查可以掩盖患有自身免疫性疾病的患者的潜在组织等离子体.

结论:

血清与ANCA阳性有关,其表现可以模仿GPA.
在接受免疫抑制疗法,特别是TNF-α抑制剂的患者中,即使在最初的负面调查中,密切监测基因质粒症至关重要.
目前的指导方针不建议在开始使用TNF-α抑制剂之前进行例行查或预防性组织等离子体治疗.

关键词:

在ANCA的积极性方面,ANCA是积极的.他们的GPA高.血清质形成的发生.TNF-α 抑制剂的使用

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