摘要
系统性红斑狼疮(SLE)是一种多器官系统受累的自身免疫性疾病,以显著的临床和分子多样性为特征,可危及生命。在SLE的发病机制中,B细胞的异常活化及其产生的自身抗体扮演着核心角色。目前,糖皮质激素、羟氯喹、免疫抑制剂以及钙调蛋白酶抑制剂是主要的治疗手段,但仍有部分患者对治疗反应不佳或反复复发。随着对SLE病理机制认识的不断深化,特异性针对B细胞的靶向治疗策略逐渐成为SLE研究的新焦点,常规治疗基础上加用靶向B细胞治疗在提高患者疾病缓解率、降低疾病活动度、降低疾病复发率、减少激素用量等方面发挥了显著作用。为了推动靶向B细胞药物在临床上的广泛应用,并实现个性化治疗,深入理解各种药物的作用机制、适应症、疗效、安全性及潜在风险至关重要。本文对B细胞在SLE发病过程中的异常活化及其关键作用作一综述,并聚焦于当前SLE治疗中几种主要的靶向B细胞方法 ,系统梳理了相关基础和临床研究的最新进展,并深入探讨了部分试验未达到预期效果的原因。此外,本文还讨论了B细胞靶向治疗面临的挑战,并对未来的发展方向进行了展望,旨在为临床医生和科研工作者提供参考,以优化SLE患者的治疗策略,期望能为SLE患者带来更有效、更安全的治疗选择。
Systemic lupus erythematosus(SLE),characterized by significant clinical and molecular diversity,is an autoimmune disease that can affect multiple organ systems,sometimes it can be life-threatening.The abnormal activation of B cells and the production of autoantibodies play a central role in the pathogenesis of SLE.Standard of care comprise glucocorticoids,hydroxychloroquine,immunosuppressive agents,and calcineurin inhibitors.Nevertheless,a subset of patients shows minimal improvement with treatment or undergo frequent relapses.As the understanding of the pathological mechanisms of SLE deepen,much more researchers focus on the area of B cell targeted therapies.Incorporating B cell targeted therapy into conventional treatment has significantly increased disease remission rates,reduced disease activity,decreased relapse rates,and minimized corticosteroid use in patients.A thorough comprehension of the mechanisms,indications,efficacy,safety,and potential risks of these therapies is essential for making targeted B cell drugs widely used in clinics and personalize treatment plans to individual patients.This review outlines the critical role of abnormal B cell activation in SLE,systematically review the latest advancements in both basic and clinical research,focusing on B cell targeted therapies,and explore the reasons why some trials have not met expected outcomes.Furthermore,the review discusses the challenges faced by targeted B cell therapy and provides a perspective on future development directions,offering valuable insights for clinicians and researchers and bringing better options to patients.
作者
张舒晴
张文博
赵东宝
ZHANG Shuqing;ZHANG Wenbo;ZHAO Dongbao(Department of Rheumatology,Changhai Hospital,Naval Medical University,Shanghai 200433,China)
出处
《中华全科医学》
2025年第9期1565-1568,共4页
Chinese Journal of General Practice
基金
上海市领军人才队伍建设专项基金(201444)。
关键词
系统性红斑狼疮
狼疮性肾炎
B细胞
靶向治疗
生物制剂
Systemic lupus erythematosus
Lupus nephritis
B cells
Targeted therapy
Biologic agents
