摘要
获得性重症肌无力是一种累及神经肌肉肌接头的自身免疫性疾病。突触后膜的乙酰胆碱受体受到免疫攻击而破坏,以致不能产生足够的终板电位,突触后膜传递功能障碍而产生肌无力。多数患者在病程的不同时期需要接受免疫治疗,并通过适当治疗获得完全或部分缓解。本文将就重症肌无力的胆碱酯酶抑制剂治疗、免疫调节治疗及胸腺切除手术的常规方法及进展进行综述。包括常用药物的剂量、用法、疗程、适应症、副作用以及针对副作用的临床对策。治疗的目标是使患者达到临床或药物缓解并将治疗的副作用降到最低。同时针对重症肌无力患者的治疗应根据疾病分型、严重程度、是否存在合并症而个体化,并强调患者的积极参与。近年来由于新型免疫抑制药物逐渐应用到重症肌无力的治疗中,使重症肌无力患者的临床转归明显改善,故本文重点介绍免疫抑制药物,特别是新型的免疫抑制剂,如环孢素A、霉酚酸酯、他克莫司及利妥昔单抗等,并介绍这些药物的治疗作用机制。
Acquired myasthenia gravis is an autoimmune disease that affects the neuromuscular junctions.The target of the autoimmune attack in most cases is the skeletal muscle acetylcholine receptor（AChR）.The final result remains muscle endplate dysfunction and muscle weakness.Most of patients with myasthenia gravis need a certain immune therapy in different courses of disease to induce a completed remission or near remission of symptoms and maintain it.In this review,the conventional methods and new progresses of management of myastheia gravis will be reviewed,including acetylcholinesterase inhibitors,immune modulationg therapy and thymectomy.The dosage,usage,course of treatment,indication,side effect of drugs and measures to side effect will be introduced.The primary aim of treatment of myasthenia gravis is induction and maintenance of clinical or pharmacologic remission while minimizing adverse effects of therapy.Treatment decisions must be individualized based on clinical classification,severity and coexisting disease,and patient participation in these decisions is essential to successful management.During the past decade,the prognosis of myasthenia gravis was improved significantly as which the imm une therapies,especiall y newly immunosuppressant was used in treatment of myasthenia gravis.So,newly immunosuppressant such as cycloporine,mycophenolate mofetil,tacrolimus,rituxmiab and their pharmacological mechanisms will be focused on in this review.
出处
《现代生物医学进展》
CAS
2013年第12期2373-2376,2381,共5页
Progress in Modern Biomedicine
基金
北京市首都临床特色应用研究"他克莫司治疗重症肌无力临床应用研究"(Z121107001012060)
关键词
重症肌无力
免疫抑制剂
治疗
Myasthenia gravis
Immunosuppressant
Treatment
