非免疫抑制药物疗法对高安动脉炎疾病进展和并发症的影响:叙述性综述。

IF 9.2 1区 医学 Q1 IMMUNOLOGY Autoimmunity reviews Pub Date : 2024-10-05 DOI:10.1016/j.autrev.2024.103656
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引用次数: 0

摘要

高安氏动脉炎是一种罕见的大血管炎,主要影响亚洲年轻女性。它会引起主动脉及其主要分支的炎症,导致主动脉狭窄和动脉瘤扩张,并因动脉粥样硬化加速而增加心血管疾病的发病率。虽然糖皮质激素能有效控制急性疾病,免疫抑制剂的初步数据也很有希望,但目前还缺乏标准化的治疗方案。使用降压药、抗血小板药、抗凝药和降脂药预防性治疗以防止血栓和缺血性并发症的问题仍存在争议。本研究回顾了非免疫抑制药物疗法对高安动脉炎疗效的证据。在PubMed数据库中搜索到了11项研究,涉及204名患者。抗血小板药物:68名患者的数据参差不齐,事实上低剂量阿司匹林不能预防36名患者的主要心血管事件,但高剂量阿司匹林可减少24名患者的缺血性并发症。抗凝剂:没有关于新型口服抗凝剂的数据,9 名患者服用维生素 K 拮抗剂没有改变心血管并发症。降压药:ACE 抑制剂可控制新血管性高血压患者的血压,但会增加急性肾功能衰退的风险,而 β 受体阻滞剂可减轻心力衰竭和主动脉瓣反流患者的症状和心肌肥厚的进展。他汀类药物:来自两个队列的数据显示,虽然他汀类药物降低了 30 名患者的动脉炎复发率,但对 13 名患者的复发率或心血管并发症没有影响。总之,考虑到高安氏动脉炎的病理生理机制和心血管风险的增加,目前的证据虽然并不确定,但支持使用非免疫抑制药物治疗来预防该病的长期并发症和损害。我们强烈鼓励开展进一步的研究。
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Impact of non-immunosuppressive medical therapy on disease progression and complications of Takayasu arteritis: A narrative review
Takayasu's arteritis is a rare large vessel vasculitis typically affecting young Asian women. It causes inflammation of the aorta and its major branches, leading to stenosis and aneurysmal dilations, and increasing cardiovascular morbidity due to accelerated atherosclerosis. Although glucocorticoids are effective for acute disease control and preliminary data on immunosuppressive drugs are promising, standardized treatment protocols are lacking. The use of prophylactic treatments with antihypertensives, antiplatelets, anticoagulants, and lipid-lowering drugs to prevent thrombotic and ischemic complications remains debated. This study reviews the evidence on the effectiveness of non-immunosuppressive medical therapy in Takayasu's arteritis. A search of the PubMed database identified eleven studies involving 204 patients. Antiplatelets: data on 68 patients were mixed, in fact low-dose aspirin did not prevent major cardiovascular events in 36 patients, but higher doses reduced ischemic complications in 24 patients. Anticoagulants: no data on new oral anticoagulants were available, and vitamin K antagonists in 9 patients did not alter cardiovascular complications. Antihypertensives: ACE-inhibitors controlled blood pressure in patients with renovascular hypertension but increased the risk of acute renal function decline, while β-blockers reduced the symptoms and the progression of myocardial hypertrophy in patients with heart failure and aortic regurgitation. Statins: data from two cohorts showed that while statins reduced the recurrence rate of arteritis in 30 patients, they did not affect recurrence rates or cardiovascular complications in 13 patients. Overall, current evidence, although not definitive, supports the use of non-immunosuppressive medical treatments to prevent long-term complications and damage in Takayasu's arteritis, considering the disease's pathophysiological mechanisms and increased cardiovascular risk. Further research is strongly encouraged.
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来源期刊
Autoimmunity reviews
Autoimmunity reviews 医学-免疫学
CiteScore
24.70
自引率
4.40%
发文量
164
审稿时长
21 days
期刊介绍: Autoimmunity Reviews is a publication that features up-to-date, structured reviews on various topics in the field of autoimmunity. These reviews are written by renowned experts and include demonstrative illustrations and tables. Each article will have a clear "take-home" message for readers. The selection of articles is primarily done by the Editors-in-Chief, based on recommendations from the international Editorial Board. The topics covered in the articles span all areas of autoimmunology, aiming to bridge the gap between basic and clinical sciences. In terms of content, the contributions in basic sciences delve into the pathophysiology and mechanisms of autoimmune disorders, as well as genomics and proteomics. On the other hand, clinical contributions focus on diseases related to autoimmunity, novel therapies, and clinical associations. Autoimmunity Reviews is internationally recognized, and its articles are indexed and abstracted in prestigious databases such as PubMed/Medline, Science Citation Index Expanded, Biosciences Information Services, and Chemical Abstracts.
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