Hauser Stephen L, Cree Bruce A C
UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco.
UCSF Weill Institute for Neurosciences and Department of Neurology, University of California, San Francisco.
Am J Med. 2020 Dec;133(12):1380-1390.e2. doi: 10.1016/j.amjmed.2020.05.049. Epub 2020 Jul 17.
Multiple sclerosis (MS) is an autoimmune demyelinating and neurodegenerative disease of the central nervous system, and the leading cause of nontraumatic neurological disability in young adults. Effective management requires a multifaceted approach to control acute attacks, manage progressive worsening, and remediate bothersome or disabling symptoms associated with this illness. Remarkable advances in treatment of all forms of MS, and especially for relapsing disease, have favorably changed the long-term outlook for many patients. There also has been a conceptual shift in understanding the immune pathology of MS, away from a purely T-cell-mediated model to recognition that B cells have a key role in pathogenesis. The emergence of higher-efficacy drugs requiring less frequent administration have made these preferred options in terms of tolerability and adherence. Many experts now recommend use of these as first-line treatment for many patients with early disease, before permanent disability is evident.
多发性硬化症（MS）是一种中枢神经系统的自身免疫性脱髓鞘和神经退行性疾病，也是年轻成人非创伤性神经残疾的主要原因。有效的管理需要多方面的方法来控制急性发作、处理病情的进行性恶化，并缓解与该疾病相关的令人烦恼或致残的症状。各种形式的MS治疗，尤其是复发型疾病的治疗取得了显著进展，这对许多患者的长期预后产生了积极影响。在理解MS的免疫病理学方面也发生了概念上的转变，从单纯的T细胞介导模型转向认识到B细胞在发病机制中起关键作用。需要给药频率更低的高效药物的出现，使其在耐受性和依从性方面成为首选。现在许多专家建议，对于许多早期疾病患者，在永久性残疾明显之前，将这些药物用作一线治疗。
