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[血管炎的治疗]

[Treatment of vasculitis].

作者信息

Novak Srdan

出版信息

Reumatizam. 2013;60(2):47-54.

Abstract

Treatment of vasculitis depends on etiology and type of vasculitis. Gluccocorticoids are drug of choice in treatment of systemic vasculitis. While in vasculitis of large vessels treatment with gluccocorticoids is often sufficient, in ANCA associated vasculitis almost always intial combination of gluccocorticoids and immunosupresive drugs (cyclofosfamide in severe forms; azatioprin and metotrrexate in moderate disease) is needed. Maintance therapy of ANCA associated vasculitis is methotrexate or azatioprin. From biologic therapy, in gigantocellular vasculitis treatment with tocilizumb has a great expectation, while in ANCA associated vasculitis recently rituximab was approved by regulatory agencies, and it is nontinferior to cyclofosfamide in induction of remission and prefarable in relapsing disease.

摘要

血管炎的治疗取决于病因和血管炎的类型。糖皮质激素是治疗系统性血管炎的首选药物。虽然在大血管血管炎的治疗中,使用糖皮质激素通常就足够了,但在抗中性粒细胞胞浆抗体(ANCA)相关血管炎中,几乎总是需要糖皮质激素与免疫抑制药物联合使用(严重形式使用环磷酰胺;中度疾病使用硫唑嘌呤和甲氨蝶呤)。ANCA相关血管炎的维持治疗药物是甲氨蝶呤或硫唑嘌呤。在生物治疗方面,在巨细胞血管炎中,托珠单抗治疗寄予厚望,而在ANCA相关血管炎中,利妥昔单抗最近已获监管机构批准,在诱导缓解方面不劣于环磷酰胺,且在复发性疾病中更具优势。

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