Honda Masaya, Koga Michiaki, Kanda Takashi
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine.
Brain Nerve. 2015 Mar;67(3):287-93. doi: 10.11477/mf.1416200133.
Central nervous system (CNS) vasculitis is classified into two categories based on whether it is primary or secondary. Primary CNS vasculitis is rare disorder of unknown cause that is restricted to the brain and spinal cord. Currently, there are no randomized clinical trials for treatment of primary CNS vasculitis. Therefore, treatment regimens for primary CNS vasculitis have been derived from therapeutic strategies used in other kinds of vasculitis. Early detection is important because corticosteroid treatment with or without cyclophosphamide can often prevent serious outcomes and may result in a favorable response. However, because some patients are intolerant or respond poorly to combination therapy, development of novel treatment options is eagerly awaited. Several immunosuppressive agents such as mycophenolate mofetil, tumor necrosis factor-α blockers, and rituximab could be options for refractory patients.
中枢神经系统(CNS)血管炎根据其是原发性还是继发性分为两类。原发性中枢神经系统血管炎是一种病因不明的罕见疾病,仅限于脑和脊髓。目前,尚无用于治疗原发性中枢神经系统血管炎的随机临床试验。因此,原发性中枢神经系统血管炎的治疗方案源自用于其他类型血管炎的治疗策略。早期检测很重要,因为使用或不使用环磷酰胺的皮质类固醇治疗通常可以预防严重后果,并可能产生良好的反应。然而,由于一些患者对联合治疗不耐受或反应不佳,人们急切期待新的治疗选择的出现。几种免疫抑制剂,如霉酚酸酯、肿瘤坏死因子-α阻滞剂和利妥昔单抗,可能是难治性患者的选择。