地中海贫血症。
Thalassaemia.
机构信息
Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon.
MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
出版信息
Lancet. 2018 Jan 13;391(10116):155-167. doi: 10.1016/S0140-6736(17)31822-6. Epub 2017 Jul 31.
Inherited haemoglobin disorders, including thalassaemia and sickle-cell disease, are the most common monogenic diseases worldwide. Several clinical forms of α-thalassaemia and β-thalassaemia, including the co-inheritance of β-thalassaemia with haemoglobin E resulting in haemoglobin E/β-thalassaemia, have been described. The disease hallmarks include imbalance in the α/β-globin chain ratio, ineffective erythropoiesis, chronic haemolytic anaemia, compensatory haemopoietic expansion, hypercoagulability, and increased intestinal iron absorption. The complications of iron overload, arising from transfusions that represent the basis of disease management in most patients with severe thalassaemia, might further complicate the clinical phenotype. These pathophysiological mechanisms lead to an array of clinical manifestations involving numerous organ systems. Conventional management primarily relies on transfusion and iron-chelation therapy, as well as splenectomy in specific cases. An increased understanding of the molecular and pathogenic factors that govern the disease process have suggested routes for the development of new therapeutic approaches that address the underlying chain imbalance, ineffective erythropoiesis, and iron dysregulation, with several agents being evaluated in preclinical models and clinical trials.
遗传性血红蛋白疾病,包括地中海贫血和镰状细胞病,是全球最常见的单基因疾病。已经描述了几种α-地中海贫血和β-地中海贫血的临床形式,包括β-地中海贫血与血红蛋白 E 共同遗传导致血红蛋白 E/β-地中海贫血。该疾病的特征包括α/β-珠蛋白链比例失衡、无效性红细胞生成、慢性溶血性贫血、代偿性造血扩张、高凝状态和肠道铁吸收增加。铁过载的并发症,源于输血,这是大多数严重地中海贫血患者疾病管理的基础,可能会进一步使临床表型复杂化。这些病理生理机制导致了一系列涉及多个器官系统的临床表现。传统的治疗主要依赖输血和铁螯合治疗,以及在特定情况下进行脾切除术。对控制疾病过程的分子和发病机制的深入了解,为开发新的治疗方法提供了途径,这些方法针对的是潜在的链失衡、无效性红细胞生成和铁失调,有几种药物正在临床前模型和临床试验中进行评估。