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达标治疗策略下系统性红斑狼疮中应用糖皮质激素的理念和发展

高岱 张卓莉

高岱, 张卓莉. 达标治疗策略下系统性红斑狼疮中应用糖皮质激素的理念和发展[J]. 中华全科医学, 2023, 21(8): 1279-1283. doi: 10.16766/j.cnki.issn.1674-4152.003102
引用本文: 高岱, 张卓莉. 达标治疗策略下系统性红斑狼疮中应用糖皮质激素的理念和发展[J]. 中华全科医学, 2023, 21(8): 1279-1283. doi: 10.16766/j.cnki.issn.1674-4152.003102
GAO Dai, ZHANG Zhuoli. Concept and development of glucocorticoid application in systemic lupus erythematosus under treat-to-target strategy[J]. Chinese Journal of General Practice, 2023, 21(8): 1279-1283. doi: 10.16766/j.cnki.issn.1674-4152.003102
Citation: GAO Dai, ZHANG Zhuoli. Concept and development of glucocorticoid application in systemic lupus erythematosus under treat-to-target strategy[J]. Chinese Journal of General Practice, 2023, 21(8): 1279-1283. doi: 10.16766/j.cnki.issn.1674-4152.003102

达标治疗策略下系统性红斑狼疮中应用糖皮质激素的理念和发展

doi: 10.16766/j.cnki.issn.1674-4152.003102
基金项目: 

北京大学第一医院科研种子基金课题 2021SF34

白求恩·普爱医学研究基金项目 PAYJ-034

北京大学第一医院国内多中心临床研究专项 2022CR53

详细信息
    通讯作者:

    张卓莉,E-mail:zhuoli.zhang@126.com

  • 中图分类号: R593.241

Concept and development of glucocorticoid application in systemic lupus erythematosus under treat-to-target strategy

  • 摘要: 糖皮质激素(简称激素)主要通过两种途径发挥作用:基因组途径和非基因组途径,前者是口服激素的主要效应通路,后者在泼尼松剂量达到100 mg/d时被激活。激素一直被认为是系统性红斑狼疮(SLE)治疗领域的“双刃剑”:一方面发挥快速而强大的抗炎及免疫抑制作用,另一方面其长期蓄积导致了大量不可逆性器官损伤的出现。迄今为止,由于缺乏更为安全有效的治疗手段,激素仍然是SLE疾病管理中最为重要的一线药物。近年研究显示,激素剂量的长期累积和减量困难,已经成为实现SLE达标治疗的首要阻碍因素。目前研究证据显示,更长的疾病稳定时间、更稳定的疾病活动状态以及更优的维持治疗方案,是实现激素顺利减停的关键。激素冲击可以激活非基因组效应途径,一方面在快速诱导疾病缓解的同时并不明显增加副作用,另一方面为口服激素起始剂量的降低和快速减量创造条件。羟氯喹、免疫抑制剂、小分子靶向药物、生物制剂等药物,也能够在一定程度上帮助激素减量。此外,包括选择性激素受体激动剂在内的新药研发,也许可以在未来发挥更为重要的作用。因此,如何实现SLE患者激素的顺利减量直至最终停用,同时维持疾病的稳定控制,日益成为风湿病学者探讨的焦点话题,需要更多高质量的循证医学证据。

     

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出版历程
  • 收稿日期:  2023-01-03
  • 网络出版日期:  2023-09-13

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