- 期刊
全身性紅斑性狼瘡腎炎治療的新進展
The Recent Advance in the Treatment of Lupus Nephritis
摘要
全身性紅斑狼瘡是一種非常重要且具代表性的自體免疫疾病，它可以侵犯身體的任何一個器官，而腎臟侵犯很常發生。嚴重的狼瘡腎炎如果不給予適當治療會進展到末期腎病(ESRD)，甚至死亡。本文主要探討瀰漫增生型狼瘡腎炎傳統與新發展的治療趨勢。高劑量類固醇加上免疫抑制劑或細胞毒殺藥物(cytotoxic agents)是現今治療該疾病的主流。對於瀰漫增生型狼瘡腎炎治療基本上分爲急性期誘導治療以達到腎炎緩解以及慢性維持治療(maintain therapy)避免復發。Cyclophosphamide-based的急性期誘導治療目前有兩大主要的治療準則：美國國家衛生研究院(NIH trial)和歐洲風濕病聯盟(ELNT trial)。近年來Mycophenolatemofetil (MMF)用於增生性狼瘡腎炎的誘導治療或維持治療都有很好的效果，且副作用較cyclophosphamide少，是另一個不錯的選擇。此外新發展的生物製劑(biologic agents)，如B細胞消除療法(B cell depleting therapy)、Abetimus sodium、Belimumab也陸續被用來治療狼瘡腎炎，其初步經驗十分令人鼓舞。如何將這些治療方式做最好的組合，使治療效果最好但副作用最少是今後努力的目標。
並列摘要
Systemic lupus erythematosus (SLE) is a common systemic autoimmune disease in the Asian population. It can involve any organ in the body and the kidney is one of organs which is most affected. About half SLE patients have lupus nephritis in their life, but approximately 10% to 15% lupus nephritis patient fail to treatment and progress to end stage renal disease (ESRD). High dose methylprednisolone plus cytotoxic agents is the treatment of choice at the present time. For diffuse proliferative lupus nephritis, the management divides into induction therapy and maintenance therapy. Cyclophosphamide-based induction therapy has two major regimens: NIH and ELNT (Euro-Lupus Nephritis Trial). In recent years, Mycophenolate mofetil (MMF) is another good choice for induction therapy because it is safer than cyclophosphamide. Azathioprine and MMF are main treatment of maintenance therapy at present. In addition, many new biologic agents are used to treat lupus nephritis recently; the preliminary experience is extremely inspiring. This article will discuss the traditional and emerging treatment of diffuse proliferative lupus nephritis.
延伸閱讀
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