利妥昔单抗在重症肌无力中的研究进展

Progress in Rituximab Treatment of Myasthenia Gravis

摘要: 重症肌无力(Myasthenia gravis, MG)是一种作用于突触后膜的致病性抗体介导的自身免疫性神经–肌肉疾病。目前临床上占比最高的抗体是抗乙酰胆碱受体(acetylcholine receptor, AChR)抗体，部分患者血清中可以检测出抗肌肉特异性酪氨酸激酶(muscle-specific tyrosine kinase, MuSK)抗体和抗低密度脂蛋白受体相关蛋白4 (low-density lipoprotein receptor-related protein 4, LRP4)抗体等。当前，MG统一认可的治疗方法有胆碱酯酶抑制剂、免疫抑制药物、静脉注射用免疫球蛋白、血浆置换、胸腺摘除手术治疗、胸腺放射治疗等。部分患者对常规免疫抑制剂耐药或不能耐受其长期应用出现的副作用，难以从中获得良好的疗效。利妥昔单抗(rituximab, RTX)是利用基因重组技术制备的一种新型针对B淋巴细胞表面CD20的人鼠嵌合型单克隆抗体。近年来，它已逐渐被证实可有效应用于MG患者，RTX可以缓解患者病情、减低复发率。RTX治疗出现的不良反应少，且很少有严重的副作用，对MG患者的治疗是安全且有效的。本文就RTX治疗MG的作用机制、临床疗效和安全性方面作一简要的综述，以期为今后MG的治疗提供重要的理论依据。

Abstract: Myasthenia gravis (MG) is a pathogenic antibody-mediated autoimmune neuromuscular disease involving postsynaptic membranes. At present, the antibody with the highest proportion in clinical practice is anti-acetylcholine receptor (AChR) antibody, and anti-muscle-specific tyrosine kinase (MuSK) antibody and anti-low-density lipoprotein receptor-related protein 4 (LRP4) antibody can be detected in the serum of some patients. The main treatment methods for MG include cholinesterase inhibitors, immunosuppressive drugs, intravenous immunoglobulin, plasma exchange, thymectomy, and thymic radiation therapy. Some patients are resistant to conventional immunosuppressants or will not tolerate their side effects, so it is difficult to obtain good curative effects from them. Rituximab (RTX) is a new type of human-mouse chimeric monoclonal antibody against CD20 on the surface of B lymphocytes developed by genetic recombination technology. In recent years, it has been gradually proved that it can be effectively used in MG patients, which can alleviate the patient’s condition and reduce recurrence. There are few adverse reactions during the RTX treatment and few of them are serious. RTX treatment is safe and effective in MG. This article briefly reviews the mechanism of action, clinical efficacy and safety of RTX in the treatment of MG, in order to provide an important theoretical basis for the treatment of MG in the future.