风湿性疾病患者的进行性多灶性白质脑病：系统性红斑狼疮患者是否有特殊风险？

Progressive multifocal leukoencephalopathy in patients with rheumatic diseases: are patients with systemic lupus erythematosus at particular risk?

作者信息

Molloy Eamonn S, Calabrese Leonard H

机构信息

Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio 44195, USA.

出版信息

Autoimmun Rev. 2008 Dec;8(2):144-6. doi: 10.1016/j.autrev.2008.07.006.

DOI:10.1016/j.autrev.2008.07.006

PMID:18700172

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare, frequently fatal, infectious complication occurring in immunocompromised patients. PML has been well-reported in patients with chronic inflammatory rheumatic diseases taking immunosuppressive drugs. Awareness of the occurrence of PML in patients with rheumatic diseases has recently been highlighted by the occurrence of several cases of PML following administration of natalizumab and rituximab, biologic agents which have been used for the treatment of rheumatic diseases. Nearly two thirds of cases of PML in patients with rheumatic diseases reported in the medical literature occurred in patients with systemic lupus erythematosus (SLE). Over 40% of PML cases in SLE occurred in patients who had had minimal iatrogenic immunosuppression, suggesting that SLE itself may predispose to PML. The mechanism of this putative predisposition of SLE patients to the development of PML remains unexplained.

摘要

进行性多灶性白质脑病（PML）是一种罕见的、常致命的感染性并发症，发生于免疫功能低下的患者。在服用免疫抑制药物的慢性炎症性风湿性疾病患者中，PML已有大量报道。近期，在使用那他珠单抗和利妥昔单抗（用于治疗风湿性疾病的生物制剂）后出现了数例PML病例，这凸显了对风湿性疾病患者发生PML的认识。医学文献报道的风湿性疾病患者中，近三分之二的PML病例发生于系统性红斑狼疮（SLE）患者。SLE患者中超过40%的PML病例发生于医源性免疫抑制程度最低的患者，这表明SLE本身可能易患PML。SLE患者对PML发生的这种假定易感性机制仍未明确。