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[自身炎症性发热疾病的治疗中得到证实的是什么?]

[What is confirmed in the treatment of autoinflammatory fever diseases?].

作者信息

Pankow Anne, Feist Eugen, Baumann Ulrich, Kirschstein Martin, Burmester Gerd-Rüdiger, Wagner Annette Doris

机构信息

Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.

Abteilung für Nieren- und Hochdruckerkrankungen, Ambulanz für seltene entzündliche Systemerkrankungen mit Nierenbeteiligung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.

出版信息

Internist (Berl). 2021 Dec;62(12):1280-1289. doi: 10.1007/s00108-021-01220-9. Epub 2021 Dec 8.

Abstract

In the last 20 years the clarification of monogenic periodic febrile diseases has led to the independent concept of autoinflammation. In this heterogeneous group polygenic complex diseases are also now included. The spectrum of symptoms is continuously growing. The main difference to autoimmunity is an excessive activation of the innate immune system without formation of autoantibodies or antigen-specific T‑cells. The cardinal symptom is recurrent fever episodes accompanied by signs of inflammation, which in the periodic manifestations alternate with intervals of general well-being. The classical monogenic diseases are also known as hereditary recurrent fever (HRF). Examples are familial Mediterranean fever (FMF), cryopyrin-associated periodic syndrome (CAPS), tumor necrosis factor receptor 1‑associated periodic syndrome (TRAPS), adenosine deaminase 2 (ADA2) deficiency and mevalonate kinase deficiency (MKD, hyper-IgD syndrome). The polygenic diseases are also known as nonhereditary fever syndromes. These include adult-onset Still's disease (AoSD), Adamantiades-Behçet disease, the PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis) and gouty arthritis. All autoinflammatory fever syndromes are accompanied by a long-term risk of development of amyloid A amyloidosis, depending on the individual severity and treatment success. In some diseases severe complications can sometimes occur.

摘要

在过去20年里,单基因周期性发热疾病的阐明催生了自身炎症这一独立概念。现在,这个异质性疾病组中还纳入了多基因复杂疾病。症状谱在不断扩大。自身炎症与自身免疫的主要区别在于先天免疫系统过度激活,却未形成自身抗体或抗原特异性T细胞。主要症状是反复发热发作并伴有炎症迹象,在周期性发作中会与全身状况良好的间歇期交替出现。经典的单基因疾病也被称为遗传性复发性发热(HRF)。例如家族性地中海热(FMF)、冷吡啉相关周期性综合征(CAPS)、肿瘤坏死因子受体1相关周期性综合征(TRAPS)、腺苷脱氨酶2(ADA2)缺乏症和甲羟戊酸激酶缺乏症(MKD,高IgD综合征)。多基因疾病也被称为非遗传性发热综合征。这些疾病包括成人斯蒂尔病(AoSD)、白塞病、PFAPA综合征(周期性发热、阿弗他口炎、咽炎和颈淋巴结炎)和痛风性关节炎。所有自身炎症性发热综合征都伴有长期发生淀粉样蛋白A淀粉样变性的风险,这取决于个体的严重程度和治疗效果。在某些疾病中,有时会出现严重并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1a0/8653393/5542df90c947/108_2021_1220_Fig1_HTML.jpg

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