他汀类药物治疗狼疮的风险和效益.ppt
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Risks and Benefits of Statins in Lupus Erythematosus
? I read with interest the article by Schattner and Liang regarding the cardiovascular burden of lupus. Cardiovascular diseases secondary to accelerated atherosclerosis are now accepted as an important cause of mortality and morbidity in patients with systemic 1upus erythematosus (SLE).
? Lowering cholesterol levels with statin therapy is one of the main targets to reduce the morbidity and mortality of SLE. However, these lipid-lowering agents may have unexpected immunologic effects.
? An increasing number of statin-induced lupuslike syndrome cases have been recently reported. Most cases were caused by second-generation statins such as simvastatin or atorvastatin. One case was associated with autoimmune hepatitis.
? Statins have also been implicated in drug-induced dermatomyositis and other types of autoimmune skin diseases such as lichen planus pemphigoides. In all cases of statin-induced lupus, skin eruption was similar to subacute lupus erythematosus with positive antinuclear antibodies.
? Unlike usual drug reactions, the skin eruption was observed only many months after starting therapy and antinuclear antibodies were still positive many months after discontinuing the drug therapy. The causal relationship between drug intake and the autoimmune disease may therefore be difficult to establish.
? Two pathogenic mechanisms may be suspected in statin-induced lupuslike syndrome. Cellular apoptosis, which plays a crucial role in SLE, may be exacerbated or triggered by second-generation statins, which are potent proapoptotic agents.
? The release of nuclear antigens into the circulation may foster the production of pathogenic autoantibodies. The same mechanism is implicated with other environmental factors such as UV light, which is a well-known triggering factor in SLE.
? The direct immunomodulator effect of statins on T lymphocytes is possibly also involved. Systemic lupus erythematosus is characterized by a shifting of Th-1 to Th-2 immune responses leading to B-ceII reactivity and production of pathogenic autoantibodies. Statin use may aggravate this phenomenon.
? Statins are among the most widely prescribed drugs. Their overall safety profile is good. However, these drugs have not only cholesterol-lowering properties but also have immunomodulator effects that may potentially trigger or aggravate autoimmune diseases. Risks and benefits of statin therapy must therefore be weighed in patients with SLE.
Risks and Benefits of Statins in Lupus Erythematosus
? I read with interest the article by Schattner and Liang regarding the cardiovascular burden of lupus. Cardiovascular diseases secondary to accelerated atherosclerosis are now accepted as an important cause of mortality and morbidity in patients with systemic 1upus erythematosus (SLE).
? Lowering cholesterol levels with statin therapy is one of the main targets to reduce the morbidity and mortality of SLE. However, these lipid-lowering agents may have unexpected immunologic effects.
? An increasing number of statin-induced lupuslike syndrome cases have been recently reported. Most cases were caused by second-generation statins such as simvastatin or atorvastatin. One case was associated with autoimmune hepatitis.
? Statins have also been implicated in drug-induced dermatomyositis and other types of autoimmune skin diseases such as lichen planus pemphigoides. In all cases of statin-induced lupus, skin eruption was similar to subacute lupus erythematosus with positive antinuclear antibodies.
? Unlike usual drug reactions, the skin eruption was observed only many months after starting therapy and antinuclear antibodies were still positive many months after discontinuing the drug therapy. The causal relationship between drug intake and the autoimmune disease may therefore be difficult to establish.
? Two pathogenic mechanisms may be suspected in statin-induced lupuslike syndrome. Cellular apoptosis, which plays a crucial role in SLE, may be exacerbated or triggered by second-generation statins, which are potent proapoptotic agents.
? The release of nuclear antigens into the circulation may foster the production of pathogenic autoantibodies. The same mechanism is implicated with other environmental factors such as UV light, which is a well-known triggering factor in SLE.
? The direct immunomodulator effect of statins on T lymphocytes is possibly also involved. Systemic lupus erythematosus is characterized by a shifting of Th-1 to Th-2 immune responses leading to B-ceII reactivity and production of pathogenic autoantibodies. Statin use may aggravate this phenomenon.
? Statins are among the most widely prescribed drugs. Their overall safety profile is good. However, these drugs have not only cholesterol-lowering properties but also have immunomodulator effects that may potentially trigger or aggravate autoimmune diseases. Risks and benefits of statin therapy must therefore be weighed in patients with SLE.
相关资料1：
- 循证性诊疗指南-子宫肌瘤的药物治疗.pdf
- 2006年罗马3功能性胃肠病诊治标准关于药物治疗的介绍(2).pdf
- 高血压病的非药物治疗方法.pdf
- 皮肤病药物治疗新进展.[陈志强 夏隆庆][2003].pdf
- 《临床药物治疗学：精神性疾病（第8版）》扫描版.pdf
- 穴位埋线配合药物治疗寻常性银屑病疗效观察.PDF
- 实用妇产科药物治疗学(第二版).pdg.rar
- 最新老年糖尿病的药物治疗进展.pdf
- 心房颤动的诊断与药物治疗(中国专家共识).pdf
- 《皮肤病药物治疗新进展》.陈志强,夏隆庆.扫描版.pdf
- 《民族民间药物治疗内科病证》.龚继民.扫描版.pdf
- 心房颤动的药物治疗.pdf
- 皮肤病药物治疗学.[靳培英][2004].pdf
- 心房颤动合并心力衰竭的药物治疗.pdf
- 中国颅脑创伤病人脑保护药物治疗指南颁布.pdf