应用奥马珠单抗患者治疗Churg-Strauss综合征
2010/01/07
关键词：美国风湿学会；抗中性粒细胞胞浆抗体；可信区间；Churg-Strauss综合征
背景：Churg-Strauss综合征（CSS）是一种少见的伴有哮喘，嗜酸性粒细胞增多，鼻窦炎，肺部浸润的全身性血管炎。有报道CSS还与哮喘治疗有关。
方法：分析应用抗IgE抗体奥马珠单抗（Xolair，基因技术公司。南加州旧金山）治疗的哮喘患者合并CSS的特征。对诺华全球药物安全数据库中收录的应用奥马珠单抗的哮喘患者的资料进行了回顾性分析以诊断CSS患者。
结果：共发现34例可能的CSS患者，其中13例至少符合美国风湿病学会6条分类标准中的4条。这13例确诊或高度可疑患者中有8名（63%）在应用奥马珠单抗前即有CSS的症状或在减撤激素后就出现症状。其中6名患者（46%）因被诊断为严重哮喘而接受激素治疗；在替换为奥马珠单抗前减撤激素时就出现了CSS症状。另外4名患者疑诊为CSS，剩余17名患者排除了CSS。
结论：存在嗜酸性细胞异常的哮喘患者在减撤激素治疗时，会凸显出其原本被哮喘治疗掩盖的症状而被诊断为CSS，在一些应用其他药物而延误治疗的患者也可见到类似现象。某些哮喘患者应用奥马珠单抗时，因为减撤激素或延迟应用激素治疗会出现原本被掩盖的CSS症状。
（马艳良 北京大学人民医院呼吸科 100044 摘译）
（Chest August 2009 136:507-518）
（Chest August 2009 136:507-518）
Churg-Strauss Syndrome in Patients Treated With Omalizumab
Michael E. Wechsler, MD, MMSc, Dennis A. Wong, MD, Mary K. Miller, MS and Lisa Lawrence-Miyasaki, RN, BSN, MA
Background: Churg-Strauss syndrome (CSS) is a rare systemic vasculitis associated with asthma, eosinophilia, sinusitis, and pulmonary infiltrates. CSS has been reported in association with asthma therapies.
Materials and methods: The objective is to describe the characteristics of CSS in patients treated with the anti-IgE antibody omalizumab (Xolair; Genentech Inc; South San Francisco, CA). A retrospective review of available data to identify cases of CSS was performed using the Novartis Argus global drug safety database for omalizumab in asthma patients.
Results: We identified 34 potential cases of CSS. Of these, 13 cases fulfilled at least four of the six criteria identified in the American College of Rheumatology classification criteria. Eight of the patients in these 13 definite or probable cases (62%) had CSS symptoms prior to receiving omalizumab or described symptom onset just after corticosteroid weaning. Six of the 13 patients (46%) were confirmed as having been treated with corticosteroids for what was perceived to be severe asthma; when corticosteroids were tapered in conjunction with omalizumab treatment, CSS symptoms appeared just after the tapering. There were 4 other cases of possible CSS, and the remaining 17 patients were judged to not have CSS.
Conclusions: CSS may develop in patients receiving asthma medications who have an underlying eosinophilic disorder that is unmasked by the withdrawal of therapy with corticosteroids, or in patients who delay therapy in favor of other medications. Omalizumab treatment may unmask CSS due to the weaning of corticosteroids in some asthma patients or may delay corticosteroid treatment allowing for CSS to manifest.
Chest August 2009 136:507-518
