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在淋巴细胞疾病中减少葡萄糖皮质激素.

Michael Toal1, Mark Canney1,2, Caitlin Hesketh1

  • 1Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada.

Kidney international reports
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PubMed
概括

葡萄糖皮质类药物 (GCs) 对质细胞疾病至关重要,但有毒性. 本综述表明,在ANCA相关的血管炎,狼性炎和IgA病中,GC节约策略可以减少暴露,同时保持有效性.

关键词:
球体疾病 球体疾病球体隆基尼弗里斯 (glomerulonephritis) 是一种发生在人体中的疾病.葡萄糖皮质类药物

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科学领域:

  • 腎臟病學 (nephrology) 是一種醫學專業.
  • 免疫学 免疫学 免疫学
  • 药理学 药理学是指药理学的学科.

背景情况:

  • 葡萄糖皮质类药物 (Glucocorticoids,简称GCs) 是由于其强烈的抗炎作用而导致球细胞疾病的主要治疗方法.
  • 由于GC的毒性,需要减少累积暴露,并探索替代策略.
  • 综述综合了主要质细胞疾病中GC节约方法的证据.

研究的目的:

  • 为了评估GC节约策略在质细胞疾病中的有效性和安全性.
  • 确定最佳的降低GC疗法和新的治疗整合.
  • 为未来的临床实践提供有关GC在病学中的使用的信息.

主要方法:

  • 随机对照试验和关键非对照研究的系统审查.
  • 对抗中性细胞细胞体抗体 (ANCA) 相关的血管炎 (AAV),狼性炎 (LN),最小变化疾病 (MCD) 和IgA脏病 (IgAN) 中GC节约策略的分析.
  • 评估PEXIVAS和LoVAS等试验的证据.

主要成果:

  • 在AAV中减少剂量的GC疗法保持有效性并降低感染风险.
  • 在LN中,低剂量的GC与向药物 (贝利马布,氨酸抑制剂,奥比努图祖马布) 结合,可促进更快的逐渐减少.
  • 与氨酸抑制剂或mycophenolate结合疗法在MCD中以较少的类固醇暴露实现缓解;IGAN实践从GC转移.
  • GCs越来越多地用于早期的,时间有限的诱导,在选择的质细胞病变.

结论:

  • 虽然GC在某些炎症性淋巴结核病的诱导中仍然是必不可少的,但它们的作用正在缩小.
  • 节省GC的策略是有效的,并降低了各种质细胞疾病中的毒性.
  • 需要对IV甲基prednisolone进行进一步的研究,以快速呈现甚至更低剂量的GC疗法.