查看“CRS”的源代码

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        <strong>细胞因子释放综合征</strong>（Cytokine Release Syndrome, CRS）是一种由于免疫细胞被诱导激活（如 [[CAR-T]] 细胞疗法、双特异性抗体或严重感染）后，短时间内释放大量[[细胞因子]]而引发的全身性炎症反应综合征。临床表现从轻微的类流感症状到致命的多器官功能衰竭不等，是细胞免疫治疗中最常见且需严格管理的严重毒副反应。
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        <div style="font-size: 1.25em; font-weight: bold; letter-spacing: 1px; text-decoration: none !important;">CRS · 临床特征图谱</div>
        <div style="font-size: 0.75em; opacity: 0.8; margin-top: 4px; white-space: nowrap; text-decoration: none !important;">Cytokine Release Syndrome (点击展开)</div>
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                [[文件:CRS_Mechanism_Icon.png|100px|CRS 发生机制核心]]
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            <div style="font-size: 0.85em; color: #64748b; margin-top: 15px; font-weight: 600;">核心机制：巨噬细胞与 T 细胞的级联激活</div>
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                <th style="text-align: left; padding: 10px 18px; border-bottom: 1px solid #f1f5f9; color: #64748b; font-weight: 600; width: 40%; background-color: #fcfdfe;">关键因子</th>
                <td style="padding: 10px 18px; border-bottom: 1px solid #f1f5f9; color: #1e293b;">[[IL-6]], [[IFN-γ]], TNF-α</td>
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                <th style="text-align: left; padding: 10px 18px; border-bottom: 1px solid #f1f5f9; color: #64748b; font-weight: 600; background-color: #fcfdfe;">首发症状</th>
                <td style="padding: 10px 18px; border-bottom: 1px solid #f1f5f9; color: #1e293b;">发热（通常 ≥38.0°C）</td>
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                <th style="text-align: left; padding: 10px 18px; color: #64748b; font-weight: 600; background-color: #fcfdfe;">首选药物</th>
                <td style="padding: 10px 18px; color: #1e293b; font-weight: bold;">[[托珠单抗]] / 糖皮质激素</td>
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    CRS 的发生并非仅由肿瘤浸润淋巴细胞直接导致，而是复杂的[[免疫细胞环路]]共同作用的结果：
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    <li style="margin-bottom: 10px;"><strong>效应细胞激活：</strong> [[CAR-T]] 细胞与肿瘤抗原结合后大量增殖，释放 IFN-γ 和 TNF-α。</li>
    <li style="margin-bottom: 10px;"><strong>髓系细胞放大：</strong> IFN-γ 激活宿主单核细胞及[[巨噬细胞]]，后者是循环中关键促炎因子（特别是 [[IL-6]] 和 IL-1）的主要来源。</li>
    <li style="margin-bottom: 10px;"><strong>内皮受损：</strong> 高浓度的细胞因子导致血管内皮细胞激活与通透性增加，引发低血压和血管源性水肿。</li>
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    根据美国移植与细胞治疗学会（ASTCT）标准，CRS 的严峻程度通过发热、低血压和缺氧三个维度进行评定：
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            <th style="padding: 12px; border: 1px solid #e2e8f0; color: #1e3a8a;">级别</th>
            <th style="padding: 12px; border: 1px solid #e2e8f0; color: #1e3a8a;">临床表现特征</th>
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            <td style="padding: 10px; border: 1px solid #e2e8f0; background: #fcfdfe; font-weight: bold;">1 级</td>
            <td style="padding: 10px; border: 1px solid #e2e8f0;">仅有发热（≥38°C），无低血压或缺氧。</td>
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            <td style="padding: 10px; border: 1px solid #e2e8f0; background: #fcfdfe; font-weight: bold;">2 级</td>
            <td style="padding: 10px; border: 1px solid #e2e8f0;">发热，伴有需要升压药或低流量吸氧的血压下降。</td>
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            <td style="padding: 10px; border: 1px solid #e2e8f0; background: #fcfdfe; font-weight: bold;">3 级</td>
            <td style="padding: 10px; border: 1px solid #e2e8f0;">发热，需要多种升压药或高流量吸氧治疗。</td>
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            <td style="padding: 10px; border: 1px solid #e2e8f0; background: #fcfdfe; font-weight: bold;">4 级</td>
            <td style="padding: 10px; border: 1px solid #e2e8f0;">发热，需要呼吸机支持（机械通气）或危及生命。</td>
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    <li style="margin-bottom: 10px;"><strong>IL-6 阻断：</strong> [[托珠单抗]]（Tocilizumab）是治疗 CRS 的基石，能迅速阻断受体信号传导。</li>
    <li style="margin-bottom: 10px;"><strong>皮质类固醇：</strong> 如[[地塞米松]]，用于控制过度的 T 细胞增殖和炎症级联，通常在 2 级及以上应用。</li>
    <li style="margin-bottom: 10px;"><strong>支持治疗：</strong> 包括大量补液、升压支持及针对潜在[[内皮损伤]]的对症处理。</li>
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        [1] Lee DW, et al. "ASTCT Consensus Grading for Cytokine Release Syndrome and ICANS." <em>Biology of Blood and Marrow Transplantation</em>. 2019. 
        <span style="color: #64748b;">(点评：确立了全球通用的 ASTCT 分级标准，是目前临床评估 CRS 最权威的指南文献。)</span>
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        [2] Norelli M, et al. "Monocyte-derived IL-1 and IL-6 are differentially required for cytokine-release syndrome and neurotoxicity." <em>Nature Medicine</em>. 2018. 
        <span style="color: #64748b;">(点评：揭示了单核细胞在 CRS 中的关键驱动作用，为靶向 IL-1 处理神经毒性提供了理论依据。)</span>
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        [3] Giavridis T, et al. "CAR T cell-induced cytokine release syndrome is mediated by macrophages and abated by IL-1 blockade." <em>Nature Medicine</em>. 2018. 
        <span style="color: #64748b;">(点评：重点阐述了巨噬细胞在毒性发生中的核心机制，对理解 CRS 的免疫全景至关重要。)</span>
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    <div style="background-color: #1e3a8a; color: #ffffff; text-align: center; font-weight: bold; padding: 12px; text-decoration: none !important;">CRS 临床关联导航</div>
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        [[CAR-T 毒性管理]] • [[ICANS]] • [[托珠单抗]] • [[巨噬细胞激活]] • [[单倍体相合移植]]
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