Deschênes J
Service d'Ophtalmologie, Université McGill, Montréal, Canada.
Bull Soc Belge Ophtalmol. 2000;276:7-11.
The increased knowledge in immunology and the progresses of pharmacology have improved our treatment of autoimmune diseases. The main anti-inflammatory effects of corticosteroids are an attenuation of the hypersensibility reactions, a sequestration of intravascular lymphocytes and an inhibition of the production of cytokines and eicosanoids. The non-steroidal anti-inflammatory drugs (NSAID's) form another group of medications particularly useful for the treatment of chronic uveitis. Several Cox-2 inhibitory medications are at the moment under clinical investigation and some are commercially available. One of their characteristics is to present less of the most undesirable side effects seen with conventional NSAID's like irritation of the gastro-intestinal tractus and platelets aggregation inhibition. Agents like cyclophosphamide, leukeran, imuran, methotrexate and cyclosporin have been used extensively for the treatment of severe uveitis. Because of its efficacy and safety, methotrexate is the best immunosuppressive agent to be tried for the treatment of chronic uveitis. However, immunosuppressive treatments and corticosteroids have many side effects and are not very selective. To improve our therapeutic arsenal, other treatments are being investigated for the treatment of severe uveitis. Manipulations of cytokines expression by Th1 lymphocytes will be one of then.
免疫学知识的增加和药理学的进展改善了我们对自身免疫性疾病的治疗。皮质类固醇的主要抗炎作用包括减轻超敏反应、隔离血管内淋巴细胞以及抑制细胞因子和类花生酸的产生。非甾体抗炎药（NSAID）是另一类对治疗慢性葡萄膜炎特别有用的药物。目前有几种Cox-2抑制药物正在进行临床研究，有些已上市。它们的一个特点是，与传统NSAID相比，其最不良的副作用较少，如胃肠道刺激和血小板聚集抑制。环磷酰胺、苯丁酸氮芥、硫唑嘌呤、甲氨蝶呤和环孢素等药物已广泛用于治疗严重葡萄膜炎。由于其有效性和安全性，甲氨蝶呤是治疗慢性葡萄膜炎的最佳免疫抑制剂。然而，免疫抑制治疗和皮质类固醇有许多副作用，且选择性不强。为了改进我们的治疗手段，正在研究其他治疗严重葡萄膜炎的方法。其中之一将是对Th1淋巴细胞的细胞因子表达进行调控。
