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[阿仑单抗诱发的格雷夫斯病]

[Alemtuzumab-induced Graves' disease].

作者信息

Sheremeta M S, Korchagina M O, Guseinova R M, Schmidt T E, Nizhegorodova K S, Sviridenko N Yu, Melnichenko G A

机构信息

Endocrinology Research Centre.

I.M. Sechenov First Moscow State Medical University.

出版信息

Probl Endokrinol (Mosk). 2023 Jun 30;69(3):51-57. doi: 10.14341/probl13238.

Abstract

Multiple sclerosis (MS) is a severe chronic autoimmune demyelinating disease of the central nervous system, mediated by Th1/Th17 lymphocytes as well as B lymphocytes, macrophages and other immune cells. Some patients with MS are treated with alemtuzumab, a monoclonal antibody against CD52+ cells, which belongs to the disease-modifying therapies (DMTs). The main effect of alemtuzumab is related to changes in immune recruitment. Alemtuzumab therapy can induce secondary autoimmunity against the background of immune rebalancing. The thyroid gland is generally involved in the autoimmune process. Graves' disease (GD) develops most often, followed by autoimmune thyroiditis.We present a clinical case of a patient with GD developed after alemtuzumab therapy for MS. The patient was referred to a radiologist at the Department of Radionuclide Therapy of Endocrinology Research Centre for radioiodine therapy (RAIT) due to relapse of thyrotoxicosis after anti-thyroid drug therapy for GD. The goal of treatment was achieved in 2 months, thyroid hormone therapy was initiated, against the background of this, there was compensation of thyroid function.

摘要

多发性硬化症(MS)是一种严重的中枢神经系统慢性自身免疫性脱髓鞘疾病,由Th1/Th17淋巴细胞以及B淋巴细胞、巨噬细胞和其他免疫细胞介导。一些MS患者接受阿仑单抗治疗,这是一种针对CD52+细胞的单克隆抗体,属于疾病修正疗法(DMTs)。阿仑单抗的主要作用与免疫募集的变化有关。阿仑单抗治疗可在免疫重新平衡的背景下诱发继发性自身免疫。甲状腺通常参与自身免疫过程。最常发生的是格雷夫斯病(GD),其次是自身免疫性甲状腺炎。我们报告了一例MS患者在接受阿仑单抗治疗后发生GD的临床病例。该患者因GD抗甲状腺药物治疗后甲状腺毒症复发,被转诊至内分泌研究中心放射性核素治疗科的放射科医生处接受放射性碘治疗(RAIT)。治疗目标在2个月内实现,开始进行甲状腺激素治疗,在此背景下,甲状腺功能得到代偿。

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