Yoshida Yoshihiro, Sakamoto Mayuko, Yokota Kazuhiro, Sato Kojiro, Mimura Toshihide
Department of Rheumatology and Applied Immunology, Faculty of Medicine, Saitama Medical University, Japan.
Intern Med. 2011;50(16):1757-60. doi: 10.2169/internalmedicine.50.4771. Epub 2011 Aug 15.
A patient with adult-onset Still's disease (AOSD) resistant to multiple drugs was treated in our hospital. Even biologics that block tumor necrosis factor (TNF) were ineffective. However, this patient responded quite well to tocilizumab, an interleukin (IL)-6 receptor blocker, suggesting that it is among the promising candidate drugs for multiple-drug resistant AOSD. Although the serum levels of most inflammatory markers such as C-reactive protein (CRP) and ferritin were reduced promptly by tocilizumab, that of IL-18 remained high. Thus, IL-18 is considered to have a further upstream position than IL-6 or to be at the same level as IL-6 in the inflammatory cascade of AOSD. This finding casts light on the pathogenesis of AOSD, and drugs that target IL-18 may prove beneficial in the treatment of this inflammatory disease.
我院收治了一名对多种药物耐药的成人斯蒂尔病（AOSD）患者。即使是阻断肿瘤坏死因子（TNF）的生物制剂也无效。然而，该患者对白细胞介素（IL）-6受体阻滞剂托珠单抗反应良好，这表明它是多药耐药AOSD的有希望的候选药物之一。尽管托珠单抗能迅速降低大多数炎症标志物如C反应蛋白（CRP）和铁蛋白的血清水平，但IL-18的水平仍然很高。因此，在AOSD的炎症级联反应中，IL-18被认为比IL-6处于更上游的位置或与IL-6处于同一水平。这一发现为AOSD的发病机制提供了线索，靶向IL-18的药物可能对治疗这种炎症性疾病有益。
