维A酸类药物治疗皮肤T细胞淋巴瘤的研究进展

Retinoids for the treatment of cutaneous T-cell lymphoma

维A酸类药物是一类维生素A衍生物,具有调节细胞增殖、分化,促进凋亡的作用并能影响人体免疫应答,其应用于皮肤T细胞淋巴瘤的治疗已有多年,疗效确切.维A酸类药物生物学作用机制主要是通过与维A酸受体和维A酸X受体结合,转录辅助活化因子和转录抑制因子参与,诱导基因转录.维A酸受体选择剂和维A酸X受体选择剂治疗皮肤T细胞淋巴瘤均有效,但联合治疗疗效更明显.维A酸类药物常与光疗、干扰素及其他免疫抑制剂联合,其联合疗法已成为其在皮肤T细胞淋巴瘤中应用的主要方式.维A酸类药物的不良反应主要表现在对肝功能、血脂、甲状腺激素水平、白细胞及生殖系统的影响,外用主要表现为皮肤刺激反应.

Retinoids are a kind of derivatives of vitamin A modulating cell proliferation,differentiation,apoptosis and altering the immune response.They have been used for years in the treatment of cutaneous T-cell lymphomas （CTCL） with definite efficacy.The biological mechanism of action of retinoids depends on their binding to retinoic acid receptor （RAR） and retinoid X receptor （RXR）,and the participation of coactivator （CoA） and corepressor （CoR）,following by the induction of gene transcription.Both RAR-and RXR-selective agents are effective for the treatment of CTCL,but combination therapies are better.Retinoids are often used in combination with phototherapy,interferon and other immunosuppressive agents,and combination therapies have become the main therapy for CTCL.Adverse reactions to oral retinoids mainly include impacts on liver function,blood lipid level,thyroid hormone level,white blood cells and reproductive system,and topical retinoids may cause irritant skin reactions.