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1型糖尿病(IDDM/T1DM)又称胰岛素依赖型糖尿病,是一种自身免疫性疾病。新近国际学术界还将其定义为重要自身免疫性疾病(IAID)中的一类。IDDM/T1DM最突出的病理生理特征是机体同时产生异常的自身体液和细胞免疫应答,最终导致胰岛β细胞损伤破坏,胰岛素分泌量绝对性减少。因此,针对IDDM/T1DM的传统主流治疗策略始终是采用胰岛素或胰岛素类似物的长期补充疗法。然而,长期使用常常会带来诸多的毒副作用尤其是低血糖反应或低血糖昏迷以及胰岛素抗性等。近年来针对其发病新机制所采用免疫抑制剂或免疫调节剂甲氨蝶呤(MTX)的临床应用备受关注,这将成为老药新用的又一重要范例。该文综述了MTX在治疗1型糖尿病方面的应用进展。
Type 1 diabetes (IDDM / T1DM), also known as insulin-dependent diabetes mellitus, is an autoimmune disease. Recently, the international academic community also defined it as one of the major autoimmune diseases (IAIDs). The most prominent pathophysiological feature of IDDM / T1DM is that the body produces abnormal self-humoral and cellular immune responses simultaneously, which eventually leads to the destruction of islet β-cell damage and the absolute decrease of insulin secretion. As a result, traditional mainstream therapeutic strategies for IDDM / T1DM have always been long-term supplementation with insulin or insulin analogues. However, long-term use often brings a lot of side effects, especially hypoglycemia or hypoglycemic coma and insulin resistance. In recent years, the clinical application of immunosuppressant or immunomodulator methotrexate (MTX) adopted in the new mechanism of its onset has attracted much attention, which will become another important new example for the old drug. This article reviews the application of MTX in the treatment of type 1 diabetes.