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題名 | 巨細胞動脈炎治療綜論與更新=Management of Giant Cell Arteritis: An Overview and Update |
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作者姓名(中文) | 劉佳美; 許舜易; | 書刊名 | 臺灣老年醫學暨老年學雜誌 |
卷期 | 14:3 2019.08[民108.08] |
頁次 | 頁125-137 |
分類號 | 417.7261 |
關鍵詞 | 巨細胞動脈炎; 類固醇; 生物製劑; Giant cell arteritis; Glucocorticoids; Biologic agent; |
語文 | 中文(Chinese) |
中文摘要 | 巨細胞動脈炎(giant cell arteritis,GCA)是一種好發於中型與大型血管的動脈炎,特別是主動脈及其近端分支、外頸動脈分支(含顳動脈),主要發生於超過50歲的長者。GCA在亞洲地區的盛行率較低,但台灣已有發生失明及舌壞死的案例報告。巨細胞動脈炎的主要治療藥物是類固醇,通常需持續使用一至二年,而長期使用類固醇可能發生糖尿病、骨折等不良事件,因此輔助類固醇減量的藥物在GCA治療占重要角色。輔助類固醇減量藥物在傳統免疫抑制劑中,有methotrexate、azathioprine及cyclophosphamide,使用免疫抑制劑可能發生肝功能和血球相關副作用。目前針對GCA的免疫機轉,生物製劑tocilizumab皮下注射劑可阻斷介白素6的細胞訊息傳遞,達到減少GCA復發及降低類固醇累計使用量的治療益處,副作用方面則與單獨使用類固醇無顯著差異。生物製劑除tocilizumab外,融和蛋白abatacept在開放性試驗中也顯示出治療益處和安全性,至於腫瘤壞死抑制劑adalimumab、infliximab及entanercept則無明顯益處,anakinra及rituximab則是研究資料不足。生物製劑的發展與研究,對GCA患者,特別是傳統免疫抑制劑耐受不佳或治療效果不理想者,是另一項理想的用藥選擇。 |
英文摘要 | Giant cell arteritis (GCA) is a vasculitis of large and medium-sized arteries that involves arteries of the carotid system, especially the temporal artery. GCA, affecting mainly patients over 50 years old, is relatively rare in Asia as compared to the West, but several cases with severe sequelae like blindness and tongue necrosis have been reported in Taiwan. The mainstream GCA treatment is glucocorticoid. Once started, glucocorticoids should be tapered gradually to avoid GCA relapse. In order to prevent steroid-related adverse effects, steroid-sparing agents are crucial in GCA treatment. Traditional agents that include methotrexate, azathioprine and cyclophosphamide may lead to side effects, such as nausea and cytopenia, that in turn may cause withdrawals. Biologic agents have been studied for GCA treatment. Tocilizumab, an interleukin-6 (IL-6) receptor antagonist, shows clinical benefits in phase III clinical trials. Tocilizumab reduces cumulative steroid dose and prevents disease relapse. For GCA patients, especially those who cannot tolerate or show inadequate response to traditional immunosuppressants, tocilizumab can be an effective and safe option. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。