托珠单抗治疗幼年特发性关节炎相关葡萄膜炎的研究进展

Progress of Tocilizumab in the Treatment of Juvenile Idiopathic Arthritis Associated Uveitis

葡萄膜炎是幼年特发性关节炎(JIA)最常见的关节外表现,多表现为反复发作的慢性前葡萄膜炎,其发病隐匿、并发症多等特点可导致患者眼部结构损伤、视力丧失。白细胞介素6(IL-6)是一种多效性细胞因子,参与炎症反应和免疫调节等过程,而托珠单抗是一种人源性IL-6受体(IL-6R)单克隆抗体,通过竞争性与IL-6R结合从而抑制IL-6的生物学活性。对于应用糖皮质激素、甲氨蝶玲和2种高剂量和(或)高频次单克隆抗体肿瘤坏死因子抑制剂治疗无效的难治性JIA相关葡萄膜炎(JIAU)患者,托珠单抗是一种新的治疗选择。现笔者就托珠单抗在JIAU中的作用机制、应用、安全性等进行综述,以期为临床决策提供参考。

Uveitis is the most common extra-articular manifestation of juvenile idiopathic arthritis(JIA).The commonest form of uveitis seen in JIA is recurrent chronic antetior uveitis with insidious onset and complications,which can lead to ocular structural damage and vision loss.Interleukin-6(IL-6)is a pleiotropic cytokine and it can promote inflammatory response and immune regulation and other processes.Tocilizumab,a humanized interleukin-6 receptor(IL-6R)monoclonal antibody,can competitively binds to IL-6 receptor,which blocks the biological effects of endogenous IL-6.For JIA associated uveitis(JIAU)patients who failed glucocorticoid,methotrexate and 2 monoclonal antibody TNFi at above-standard dose and/or frequency,tocilizumab becomes a new treatment option for JIAU.This paper mainly summarizes the mechanism,application and safety of tocilizumab in the treatment of JIAU in order to provide reference for clinical decision-making.