“系统性红玟妊狼疮”眼中的羟氯喹

2022-07-02 August MedSci原创 发表于上海

羟氯喹(HCQ)是一种用于治疗系统性红斑狼疮(SLE)和类风湿关节炎(RA)的改善疾病的抗风湿药物,与甲氨蝶呤和柳氮磺胺吡啶一起构成RA三联疗法的一部分。此外,HCQ还用于其他结缔组织疾病和皮肤病。

羟氯喹(HCQ)是一种用于治疗系统性红斑狼疮(SLE)和类风湿关节炎(RA)的改善疾病的抗风湿药物,与甲氨蝶呤和柳氮磺胺吡啶一起构成RA三联疗法的一部分。此外,HCQ还用于其他结缔组织疾病和皮肤病。

在SLE中,HCQ被推荐为治疗的基石。50多年来,治疗的适应症一直是观察到的对关节疼痛、皮肤影响和疲劳的有益影响,但在过去10-15年中,HCQ的经验效应得到了大量科学证据的支持,证明了治疗的许多临床效果。治疗可提高患者生存率,减少疾病活动,减少肾损伤,并降低严重共病的风险,包括血栓栓塞疾病和妊娠并发症。HCQ已被证明可以减少系统性红斑狼疮发作的数量和严重程度,并与较低的感染风险相关。在RA患者和SLE患者中,HCQ也与胰岛素抵抗和血脂异常降低有关。因此,HCQ是一种有助于降低这些患者死亡率的中心治疗方法。

研究表明HCQ可以降低复发的风险,减少类固醇的剂量,减少器官损伤,并防止抗磷脂抗体的血栓性作用。该药物通常是安全的,可以给孕妇开处方。然而,需要注意预防视网膜病变,这是长期使用HCQ的罕见但严重的并发症。

计算机控制的周长和光学相干层析成像(OCT)等新方法能够早期检测使用HCQ造成的损伤,这使接受治疗的患者的剂量建议和监测发生了变化,因为新方法表明,接受较低剂量的患者在接受较高剂量或长期累积治疗时根本不会出现视网膜损伤。

现在推荐使用计算机控制的周长和OCT检查方法对接受HCQ治疗的患者进行常规监测,可能有助于在中心视力受到影响之前检测视网膜毒性。在这些早期阶段中止HCQ治疗可能会减少或防止永久性眼睛损伤的发展。

基于上述情况,对使用 HCQ 治疗的患者进行监测的建议已更改

HCQ是一种对SLE和其他结缔组织疾病患者有许多有益作用的制剂,在随后的治疗中,HCQ很少导致视觉损伤。开HCQ的医生必须了解视网膜病变和其他副作用的发病率和风险因素,以便患者获得正确的治疗信息和知识。开处方的医生应了解国家和国际药物使用指南,并根据这些指南对患者进行监测,但同时不要受到不适当的严密控制和不必要的恐惧。HCQ耐受性良好,该药物的有益作用远大于与治疗相关的相对较少的副作用。

专家意见:HCQ不仅对轻度SLE患者具有多种优势,而且对器官受累的狼疮患者和孕妇也具有重要的有益作用。这种药成本低,副作用少。这些特点应鼓励更多地使用HCQ,也适用于器官受累的狼疮患者。

 

参考文献:

1. Troldborg A, Bay-Laurberg T, Clemmensen K, Andersen J, Deleuran B. [Hydroxychloroquine treatment rarely causes eye damage when used correctly]. Ugeskr Laeger. 2020 Aug 3;182(32):V02200115. Danish. PMID: 32800050.

2. Ponticelli C, Moroni G. Hydroxychloroquine in systemic lupus erythematosus (SLE). Expert Opin Drug Saf. 2017 Mar;16(3):411-419. doi: 10.1080/14740338.2017.1269168. Epub 2016 Dec 14. PMID: 27927040.

 

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    2022-07-03 huaguang

    HCQ是治疗狼疮药物的基石

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在这个SLE纵向队列中确定了SLE亚型相关CpG的一个子集,它们随着时间的推移是稳定的,并且可能可用作疾病亚型的生物标志物。与全基因组甲基化组相比,另一个与SLE亚型相关的CpG子集的变化比例更高。

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研究系统性红斑狼疮(SLE)患者血浆中代谢物的变化,以识别新的生物标志物,为SLE发病机制提供线索。

A&R:系统性红斑狼疮的共享和亚洲特异性基因座的鉴定以及III型干扰素信号传导和溶酶体功能在该疾病中作用的证据:一项多祖先全基因组关联研究

在这项研究中,确定了系统性红斑狼疮(SLE)的共享位点和亚洲特异性位点,功能注释提供了增加III型干扰素信号传导和降低SLE溶酶体功能参与的证据。