克罗恩病和自身免疫

Crohn's disease and autoimmunity

克罗恩病(Crohn’s disease,CD)是自身免疫性疾病,其本质是自身免疫,活动期都有Th17/Treg和Th1/Treg反应失衡及Treg细胞数量减少和抑制Th17细胞功能障碍的缺陷,这一缺陷可导致免疫失耐受。现知Th17细胞参与和促进自身免疫的发生与发展,同时又分泌大量促炎细胞因子,引起肠道组织损伤,而Treg细胞却能抑制自身免疫,抑制Th17细胞和Th1细胞及其免疫反应,维持自身耐受。治疗的重点是增进Treg反应并长期维持Tregs占优势。糖皮质激素及三联疗法能增加Treg细胞抑制自身免疫,还有抗炎、抗纤维化等作用,因此需长期服用,而糖皮质激素已是CD治疗不可缺少的药物。

Crohn’s disease is an autoimmune disease with autoimmunity as its essence. Th17 cells participate and promote the generation and progression of autoimmunity while Treg cells are antagonistic and inhibit autoimmunity as well as responsible for tolerance against self-antigens. With presence of Th17/Treg imblance plus numerical （less numerous with active disease） and functional （suppressive impairment） defects can lead to loss of tolerance. Glucocorticoid or triple therapy can upgrade Treg cells number and the ability of autoimmunity inhibition, and play key roles in Crohn’s disease therapeutics. Glucocorticoid use is indispensable for Crohn’s disease therapy.