摘要
系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种以多脏器受累及多种自身抗体阳性为主要特点的自身免疫性疾病,多发于育龄期女性.全基因组关联研究、宏基因组研究、表观遗传学研究、单细胞测序、免疫代谢研究及多组学研究在SLE的发病机制研究中发挥着日益重要的作用.自身抗体在SLE的诊断和病情监测中起重要作用.目前临床研究和临床实践中最常应用的是2012年系统性红斑狼疮国际合作组制定的分类标准和2019年欧洲抗风湿病联盟/美国风湿病学会制定的分类标准.SLE的诊治应贯彻早期诊断、早期治疗的原则,以实现尽快控制病情、减少器官损伤累积、改善患者的长期生活质量和提高长期存活率的目标.“达标治疗”理念的提出,将进一步提高SLE的整体治疗水平,但由于SLE疾病的高度异质性,应在遵循规范治疗的前提下,体现个体化.除常用的治疗药物如糖皮质激素、抗疟药、免疫抑制剂外,以B细胞为靶向的生物制剂为SLE的治疗提供了新的选择,将成为未来的发展方向.干细胞治疗也有着良好的应用前景.随着SLE患者预后的改善,围妊娠期管理和早发动脉粥样硬化症的防治越来越受到风湿免疫科医师的重视.本文综述了近年来SLE的诊治方向和研究前沿,以期为风湿科医师和研究者提供参考.
Systemic Lupus Erythematosus(SLE)is an autoimmune disease characterized by multi-system involvement and multiple autoantibodies.It mainly occurs in women of childbearing age.Genome-wide association study,metagenomics,epigenetics,singlecell sequencing,immunometabolic study,and multi-omics study are playing an increasingly important role in the pathogenesis research of SLE.Autoantibodies are critical in the diagnosis and disease monitoring of SLE.The 2012 Systemic Lupus International Collaborating Clinics(SLICC)classification criteria and the 2019 European League Against Rheumatism(EULAR)/American College of Rheumatology(ACR)classification criteria are most commonly used criteria in clinical research and practice.Early diagnosis and early treatment of SLE are the principles that should be followed to promptly control the disease,prevent organ damage accrual,improve long-term quality of life,and prolong survival.The“treat-to-target(T2T)”concept will help improve the treatment of SLE.However,due to the great heterogeneity of the disease,treatment should be individualized under the premise of following the T2T concept.In addition to commonly used medications for SLE such as glucocorticoids,antimalarials,and immunosuppressants,biologic agents targeting B cells provide new therapeutic choices,and will become a future direction of SLE treatment.Stem cell therapy also has a good application prospect.With the improvement of SLE prognosis,rheumatologists are paying more attention to perinatal management and prevention of early atherosclerosis.This paper reviews the diagnosis and treatment directions and research frontiers of SLE in recent years to provide reference for rheumatologists and researchers.
作者
姜楠
白炜
赵久良
张上珠
吴婵媛
王立
赵丽丹
李菁
胡朝军
王迁
徐东
冷晓梅
张文
李梦涛
田新平
曾小峰
JIANG Nan;BAI Wei;ZHAO JiuLiang;ZHANG ShangZhu;WU ChanYuan;WANG Li;ZHAO LiDan;LI Jing;HU ChaoJun;WANG Qian;XU Dong;LENG XiaoMei;ZHANG Wen;LI MengTao;TIAN XinPing;ZENG XiaoFeng(Department of Rheumatology and Clinical Immunology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,National Clinical Research Center for Dermatologic and Immunologic Diseases(NCRC-DID),Ministry of Science&Technology of China,State Key Laboratory of Complex Severe and Rare Diseases,Key Laboratory of Rheumatology and Clinical Immunology,Ministry of Education of China,Beijing 100730,China)
出处
《中国科学：生命科学》
CSCD
北大核心
2021年第8期887-900,共14页
Scientia Sinica(Vitae)
基金
国家重点研发计划精准医学专项(批准号:2017YFC0907601,2017YFC0907602,2017YFC0907603)
北京市科学技术委员会(批准号:Z201100005520022,Z201100005520023,Z201100005520025,Z201100005520026,Z201100005520027)
中国医学科学院医学与健康科技创新工程项目(批准号:2019-I2M-2-008)资助。
关键词
系统性红斑狼疮
流行病学
发病机制
诊断
治疗方案
研究进展
systemic lupus erythematosus
epidemiology
pathogenesis
diagnosis
therapeutic regimen
research advance
