华西医学

华西医学

视神经脊髓炎相关性视神经炎的治疗策略

查看全文

视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorders,NMOSD)是一组主要累及视神经和脊髓以免疫介导的脱髓鞘和轴突损伤为特征的中枢神经系统炎症性疾病,其中视神经脊髓炎相关性视神经炎(neuromyelitis optica related neuritis,NMO-ON)是引起患者视力严重下降的常见神经眼科疾病。水通道蛋白 4 抗体的发现,证实视神经脊髓炎是一种不同于多发性硬化的独立疾病实体。NMO-ON 治疗的 2 个主要目标是控制急性炎症和预防复发。随着对 NMOSD 发病机制的深入研究,针对疾病发生过程中不同靶点的新的治疗方法不断出现。该文就 NMO-ON 的治疗现状和免疫治疗策略进行了综述。

Neuromyelitis optica spectrum disorders (NMOSD) are a group of inflammatory disorders of the central nervous system characterized by episodes of immune-mediated demyelination and axonal damage mainly involving optic nerves and spinal cord. Neuromyelitis optica related optic neuritis (NMO-ON) is a common neuro-ophthalmic disease which often results in permanent blindness. The discovery of aquaporin 4 antibodies confirms that neuromyelitis optica is a distinct disease entity different from multiple sclerosis. In patients with NMO-ON, the correct therapeutic approach has to recognize two distinct clinical situations: treatment of the acute attacks and prevention of the relapses. With the in-depth study of the pathogenesis of NMOSD, new treatments are emerging in different targets of the disease. This review gives an update of latest treatment of NMO-ON, emphasizing both current situation and future immunotherapy strategies.

关键词: 视神经脊髓炎谱系疾病; 视神经炎; 水通道蛋白 4; 免疫治疗

Key words: Neuromyelitis optica spectrum disorders; Optic neuritis; Aquaporin 4; Immunotherapy

引用本文: 宋宏鲁, 魏世辉. 视神经脊髓炎相关性视神经炎的治疗策略. 华西医学, 2018, 33(11): 1339-1343. doi: 10.7507/1002-0179.201810054 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1. Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet, 2004, 364(9451): 2106-2112.
2. 中华医学会眼科学分会神经眼科学组. 视神经炎诊断和治疗专家共识 (2014 年). 中华眼科杂志, 2014, 6(6): 459-463.
3. Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology, 2015, 85(2): 177-189.
4. Amiry-Moghaddam M, Frydenlund DS, Ottersen OP. Anchoring of aquaporin-4 in brain: molecular mechanisms and implications for the physiology and pathophysiology of water transport. Neuroscience, 2004, 129(4): 999-1010.
5. Phuan PW, Ratelade J, Rossi A, et al. Complement-dependent cytotoxicity in neuromyelitis optica requires aquaporin-4 protein assembly in orthogonal arrays. J Biol Chem, 2012, 287(17): 13829-13839.
6. 康皓, 魏世辉. NMO-IgG 导致视神经脊髓炎相关视神经炎的机制研究进展. 中国中医眼科杂志, 2015, 25(6): 448-452.
7. 郭俊, 李宏增, 李柱一. 视神经脊髓炎谱系疾病的免疫治疗策略. 中华神经科杂志, 2017, 50(6): 401-404.
8. Höftberger R, Sepulveda M, Armangue T, et al. Antibodies to MOG and AQP4 in adults with neuromyelitis optica and suspected limited forms of the disease. Mult Scler, 2015, 21(7): 866-874.
9. Melamed E, Levy M, Waters PJ, et al. Update on biomarkers in neuromyelitis optica. Neurol Neuroimmunol Neuroinflamm, 2015, 2(4): e134.
10. Bruscolini A, Sacchetti M, La Cava M, et al. Diagnosis and management of neuromyelitis optica spectrum disorders: an update. Autoimmun Rev, 2018, 17(3): 195-200.
11. Trebst C, Jarius S, Berthele A, et al. Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS) . J Neurol, 2014, 261(1): 1-16.
12. 中国免疫学会神经免疫学分会. 中国视神经脊髓炎谱系疾病诊断与治疗指南. 中国神经免疫学和神经病学杂志, 2016, 23(3): 155-166.
13. Abboud H, Petrak A, Mealy M, et al. Treatment of acute relapses in neuromyelitis optica: steroids alone versus steroids plus plasma exchange. Mult Scler, 2016, 22(2): 185-192.
14. 谭少英, 魏世辉, 徐全刚, 等. 血浆置换治疗视神经脊髓炎相关视神经炎值得注意的问题. 中华眼底病杂志, 2017, 33(5): 445-448.
15. Mealy MA, Wingerchuk DM, Palace J, et al. Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: multicenter study of treatment efficacy. JAMA Neurol, 2014, 71(3): 324-330.
16. 王均清, 徐全刚, 周欢粉, 等. 小剂量利妥昔单抗预防视神经脊髓炎谱系疾病复发的有效性及安全性观察. 中华眼底病杂志, 2018, 34(2): 155-158.
17. Ringelstein M, Ayzenberg I, Harmel J, et al. Long-term therapy with interleukin 6 receptor blockade in highly active neuromyelitis optica spectrum disorder. JAMA Neurol, 2015, 72(7): 756-763.
18. Ayzenberg I, Kleiter I, Schröder A, et al. Interleukin 6 receptor blockade in patients with neuromyelitis optica nonresponsive to anti-CD20 therapy. JAMA Neurol, 2013, 70(3): 394-397.
19. Pittock SJ, Lennon VA, Mckeon A, et al. Eculizumab in AQP4-IgG-positive relapsing neuromyelitis optica spectrum disorders: an open-label pilot study. Lancet Neurol, 2013, 12(6): 554-562.
20. Tradtrantip L, Zhang H, Saadoun S, et al. Anti-aquaporin-4 monoclonal antibody blocker therapy for neuromyelitis optica. Ann Neurol, 2012, 71(3): 314-322.
21. Saadoun S, Waters P, Macdonald C, et al. Neutrophil protease inhibition reduces neuromyelitis optica-immunoglobulin G-induced damage in mouse brain. Ann Neurol, 2012, 71(3): 323-333.
22. Zhang H, Verkman AS. Eosinophil pathogenicity mechanisms and therapeutics in neuromyelitis optica. J Clin Invest, 2013, 123(5): 2306-2316.
23. Levy M, Mealy MA. Purified human C1-esterase inhibitor is safe in acute relapses of neuromyelitis optica. Neurol Neuroimmunol Neuroinflamm, 2014, 1(1): e5.
24. Tradtrantip L, Asavapanumas N, Phuan PW, et al. Potential therapeutic benefit of C1-esterase inhibitor in neuromyelitis optica evaluated in vitro and in an experimental rat model. PLoS One, 2014, 9(9): e106824.
25. Phuan PW, Zhang H, Asavapanumas N, et al. C1q-targeted monoclonal antibody prevents complement-dependent cytotoxicity and neuropathology in in vitro and mouse models of neuromyelitis optica. Acta Neuropathol, 2013, 125(6): 829-840.
26. Bar-Or A, Steinman L, Behne JM, et al. Restoring immune tolerance in neuromyelitis optica: PartⅡ. Neurol Neuroimmunol Neuroinflamm, 2016, 3(5): e277.