托珠单抗在难治性成人Still病中实现激素减停1例并文献复习

doi:10.3969/j.issn.1004-583X.2025.11.008

临床荟萃 ›› 2025, Vol. 40 ›› Issue (11): 1016-1021.doi: 10.3969/j.issn.1004-583X.2025.11.008

托珠单抗在难治性成人Still病中实现激素减停1例并文献复习

罗伦菊¹, 邓翼遥², 李正胜³, 薛秋玲¹, 查艳², 袁静²()

1.贵州中医药大学,贵州贵阳 550005
2.贵州省人民医院肾内科/国家卫生健康委员会肺脏免疫性疾病诊治重点实验室/贵州省常见慢性疾病发病机制及防治全省重点实验室,贵州贵阳 550002
3.贵州中医药大学第二附属医院肾内科,贵州贵阳 550003

收稿日期:2025-09-11 出版日期:2025-11-20 发布日期:2025-12-02
通讯作者: 袁静 E-mail:yuanjinger@126.com
基金资助:
2024年度贵州省卫生健康高质量发展医学科研联合基金资助——XIST m6A甲基化修饰促进糖尿病肾脏慢性炎症及肾间质纤维化的分子机制研究(2024GZYXKYJJXM007);2025年贵州省基础研究计划(自然科学)面上项目和重点项目——WTAP介导XRNI m6A甲基化修饰通过激活自噬改善糖尿病肾脏病肾间质纤维化的机制研究([黔科合基础MS(2025)494])

Tocilizumab enables glucocorticoid reduction in refractory adult-onset Still’s disease: A case report and literature review

Luo Lunju¹, Deng Yiyao², Li Zhengsheng³, Xue Qiuling¹, Zha Yan², Yuan Jing²()

1. Guizhou University of Traditional Chinese Medicine, Guiyang 550005, China
2. Department of Nephrology/NHC Key Laboratory of Pulmonary Immunological Disease/Guizhou Provincial Key Laboratory of Pathogenesis and Prevention of Common Chronic Diseases Research, Guizhou Provincial People's Hospital, Guiyang 550002, China
3. Department of Nephrology, the 2nd Affiliated Hospital of Guizhou University of TCM, Guiyang 550003, China

Received:2025-09-11 Online:2025-11-20 Published:2025-12-02
Contact: Yuan Jing E-mail:yuanjinger@126.com

摘要/Abstract

摘要：

目的探讨难治性成人Still病(adult-onset Still’s disease, AOSD)的临床特征及诊疗策略。方法回顾性分析1例合并巨噬细胞活化综合征(macrophage activation syndrome, MAS)和急性肝功能衰竭(acute hepatic failure, ALF)的AOSD患者的诊疗过程,探索白细胞介素-6受体抑制剂托珠单抗的临床价值,并复习相关文献。结果患者,女,24岁,确诊AOSD,在使用大剂量激素治疗后进展为MAS(HScore评分329分)和ALF。采用托珠单抗联合血浆置换治疗后,患者体温恢复正常,肝功能显著改善,炎症指标显著下降。结论托珠单抗可用于治疗难治性AOSD合并MAS和ALF,其在快速控制病情、实现激素减停方面展现出一定的潜力,但长期安全性有待进一步研究验证。

关键词: 成人Still病, 巨噬细胞活化综合征, 肝功能衰竭, 托珠单抗

Abstract:

Objective To investigate the clinical features, diagnostic challenges, and treatment approaches for refractory adultonset Still’s disease (AOSD). Methods We performed a retrospective analysis of a patient with AOSD complicated by macrophage activation syndrome (MAS) and acute liver failure (ALF), evaluating the clinical response to tocilizumab, an interleukin6 (IL6) receptor antagonist. Relevant literature was reviewed to contextualize the findings. Results A 24-year-old female with AOSD progressed to MAS (HScore 329) and ALF despite highdose corticosteroid therapy. Treatment with tocilizumab combined with plasma exchange led to rapid normalization of body temperature, marked improvement in liver function, and substantial reductions in inflammatory markers. Conclusion This case demonstrates that tocilizumab can induce rapid remission in refractory AOSD complicated by MAS or ALF and facilitate tapering of glucocorticoids; however, its longterm safety in this setting require further study.

Key words: adult-onset Still's disease, macrophage activation syndrome, hepatic failure, tocilizumab

中图分类号:

R593.2

罗伦菊, 邓翼遥, 李正胜, 薛秋玲, 查艳, 袁静. 托珠单抗在难治性成人Still病中实现激素减停1例并文献复习[J]. 临床荟萃, 2025, 40(11): 1016-1021.

Luo Lunju, Deng Yiyao, Li Zhengsheng, Xue Qiuling, Zha Yan, Yuan Jing. Tocilizumab enables glucocorticoid reduction in refractory adult-onset Still’s disease: A case report and literature review[J]. Clinical Focus, 2025, 40(11): 1016-1021.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.11.008

https://www.lchc.cn/CN/Y2025/V40/I11/1016

图/表 2

图1 人工肝治疗后ALT、AST、TBIL逐渐恢复正常

Fig.1 The levels of ALT, AST, and TBIL gradually returned to normal after artificial liver treatment

图2 甲泼尼龙片、CsA联合托珠单抗治疗后,相关指标有所下降:应用托珠单抗后,病程中第1次出现铁蛋白、CRP、WBC、血沉升高,考虑为托珠单抗减量治疗所致;第2次实验室指标升高,考虑患者未规律使用托珠单抗

Fig.2 After treatment with methylprednisolone, CsA, and tocilizumab, the above-mentioned indicators decreased. After treatment with tocilizumab, the levels of ferritin, CRP, WBC, and ESR increased for the first time with the reduction of tocilizumab during the course of the disease. The second increase in laboratory indicators was considered to be due to the patient's irregular use of tocilizumab.

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托珠单抗在难治性成人Still病中实现激素减停1例并文献复习

Tocilizumab enables glucocorticoid reduction in refractory adult-onset Still’s disease: A case report and literature review

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