免疫抑制剂治疗药物监测在风湿病中的应用

doi:10.16138/j.1673-6087.2025.06.13

摘要/Abstract

摘要：

风湿病是一类以关节、肌肉、骨骼等系统慢性炎症或疼痛为主要表现的疾病，其病因复杂、病程长，且常伴有免疫系统紊乱。免疫抑制剂通过抑制免疫系统的过度反应，能够减轻炎症和自身免疫损伤，被广泛应用于风湿病的治疗。然而，因此类药物治疗窗窄、个体差异大，在控制病情的同时，易引发肝肾功能损害、感染等严重不良反应。治疗药物监测（therapeutic drug monitoring, TDM）通过监测患者体液中药物浓度优化治疗方案，从而提高疗效并降低不良反应的发生。本文将对风湿病治疗中免疫抑制剂的种类、TDM技术进展及其在风湿病中的研究进展进行综述，以提高医师对该技术的认知与重视。

关键词: 风湿病, 免疫抑制剂, 治疗药物监测, 药物浓度

Abstract:

Rheumatism is a group of diseases primarily characterized by chronic inflammation or pain in the joints, muscles, and bones. The etiology is complex, and the disease processes are protracted and are often accompanied by immune system disorders. Immunosuppressive drugs are widely used in the treatment of rheumatism because they can effectively suppress the overreaction of the immune system, thus reducing inflammation and autoimmune damage. However, as the immunosuppressive drugs have narrow therapeutic window and exhibit significant individual variations, they carry a high risk of severe adverse effects such as hepatorenal damage and infection while controlling the disease. Therapeutic drug monitoring (TDM) optimizes treatment regimens by monitoring the drug concentration in patient body fluids, thereby enhancing efficacy and reducing the incidence of adverse effects. This article reviews the types of immunosuppressants used in the treatment of rheumatism, the advances in TDM technology and relevant research progress in rheumatism, aiming to improve doctors’ understanding and attention to this technology.

Key words: Rheumatism, Immunosuppressant, Therapeutic drug monitoring, Drug concentration

中图分类号:

R593.2

康新, 杨婷, 徐霞, 高丽红, 孔瑞娜, 杨云云, 黄晓会, 王卓, 高洁. 免疫抑制剂治疗药物监测在风湿病中的应用[J]. 内科理论与实践, 2025, 20(06): 500-504.

KANG Xin, YANG Ting, XU Xia, GAO Lihong, KONG Ruina, YANG Yunyun, HUANG Xiaohui, WANG Zhuo, GAO Jie. Application of therapeutic drug monitoring in immunosuppressant treatment of rheumatism[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(06): 500-504.

图/表 1

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风湿免疫性疾病	CsA血药谷浓度	TAC血药谷浓度
1）：剂量来源于已发表研究和已发表的共识或指南；2）：剂量来源于病例报告、病例系列或专家共识，无其他可参考依据； 3）：剂量仅来源于相关疾病诊治共识；其他剂量范围来源于随机对照试验或队列研究。
成人SLE	75~200	3~10
儿童狼疮性肾炎	75~200 ^1）	5~15 ^1）
RA	75~150	/
多发性肌炎/皮肌炎	100~250	5~10
幼年皮肌炎	60~300	5~15 ^3）
自身免疫性肝炎	100~300	3~8
系统性硬化病	/	5~15
抗中性粒细胞胞浆抗体相关性血管炎	60~200	/
白塞病	/	<15 ^2）