Department of Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO 80045, USA.
J Allergy Clin Immunol. 2010 Feb;125(2 Suppl 2):S226-37. doi: 10.1016/j.jaci.2009.09.053.
Autoimmunity affects multiple glands in the endocrine system. Animal models and human studies highlight the importance of alleles in HLA-like molecules determining tissue-specific targeting that, with the loss of tolerance, leads to organ-specific autoimmunity. Disorders such as type 1A diabetes, Graves disease, Hashimoto thyroiditis, Addison disease, and many others result from autoimmune-mediated tissue destruction. Each of these disorders can be divided into stages beginning with genetic susceptibility, environmental triggers, active autoimmunity, and finally metabolic derangements with overt symptoms of disease. With an increased understanding of the immunogenetics and immunopathogenesis of endocrine autoimmune disorders, immunotherapies are becoming prevalent, especially in patients with type 1A diabetes. Immunotherapies are being used more in multiple subspecialty fields to halt disease progression. Although therapies for autoimmune disorders stop the progress of an immune response, immunomodulatory therapies for cancer and chronic infections can also provoke an unwanted immune response. As a result, there are now iatrogenic autoimmune disorders arising from the treatment of chronic viral infections and malignancies.
自身免疫会影响内分泌系统的多个腺体。动物模型和人类研究强调了 HLA 样分子中等位基因的重要性,这些等位基因决定了组织特异性靶向,随着耐受性的丧失,导致器官特异性自身免疫。1 型糖尿病、格雷夫斯病、桥本甲状腺炎、艾迪生病等多种疾病都是由自身免疫介导的组织破坏引起的。这些疾病中的每一种都可以分为几个阶段,从遗传易感性、环境触发因素、活跃的自身免疫,最后是代谢紊乱和明显的疾病症状。随着对内分泌自身免疫性疾病的免疫遗传学和免疫发病机制的深入了解,免疫疗法越来越流行,尤其是在 1 型糖尿病患者中。免疫疗法在多个亚专科领域中被更多地用于阻止疾病进展。尽管自身免疫性疾病的治疗可以阻止免疫反应的进展,但癌症和慢性感染的免疫调节疗法也可能引发不必要的免疫反应。因此,现在由于治疗慢性病毒感染和恶性肿瘤,出现了医源性自身免疫性疾病。