脉络膜新生血管发生与治疗中的免疫学机制  

Immunological mechanisms underlying the pathogenesis and treatment of choroidal neovascularization

作　　者：季春翊 计菁[1] Ji Chunyi;Ji Jing(Department of Ophthalmology,Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院眼科,上海200011

出　　处：《国际眼科纵览》2025年第1期38-44,共7页International Review of Ophthalmology

基　　金：国家自然科学基金(82271131)。

摘　　要：新生血管性年龄相关性黄斑变性(neovascular age-related macular degeneraion,NVAMD)的核心病理特征在于脉络膜新生血管(choroidal neovascularization,CNV)的形成,其形成机制纷繁复杂,尚未完全阐明。目前,抗血管内皮生长因子(vascular endothelial growth factor,VEGF)疗法作为NVAMD治疗的一线策略,虽已取得初步成功,但患者无法长期获益的不足日益凸显。研究发现,免疫系统的多种关键因素在CNV形成中发挥了重要作用。巨噬细胞(macrophage,Mo)的募集和极化在这一过程中具有双重作用,其中向M2表型极化会促进CNV的形成;补体级联反应、炎性小体的激活及促炎因子的分泌进一步推动Mo的募集和极化,从而加剧CNV病变进展。基于这些机制,联合使用补体抑制剂、抗炎因子以及巨噬细胞极化调节剂,不仅能够辅助抗VEGF疗法减缓或逆转CNV进程,还能有效减少耐药性的发生,为NVAMD患者提供了新的治疗策略和希望。The core pathological feature of neovascular age-related macular degeneration(NVAMD)is the formation of choroidal neovascularization(CNV).The mechanisms underlying CNV formation are complex and not yet fully understood.Currently,vascular endothelial growth factor(VEGF)inhibitors are the first-line treatment for NVAMD and have achieved preliminary success.However,the inability of patients to benefit from long-term outcomes has become increasingly apparent.Recent studies have identified multiple critical immune factors that play significant roles in CNV formation.The recruitment and polarization of macrophages(Mo)are central to this process,with M2 polarization promoting CNV progression.Additionally,complement cascade activation,inflammasome activation,and the secretion of pro-inflammatory cytokines further drive macrophage recruitment and polarization,exacerbating CNV lesions.Based on these findings,combining complement inhibitors,anti-inflammatory cytokines,and macrophage polarization modulators with anti-VEGF therapy holds potential not only to slow or reverse CNV progression but also to reduce the occurrence of therapeutic resistance,offering new hope for NVAMD patients.

关 键 词：新生血管性年龄相关性黄斑变性 脉络膜新生血管 免疫反应 

分 类 号：R774.5[医药卫生—眼科]