查看“赛妥珠单抗”的源代码

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            <strong>[[赛妥珠单抗]]</strong>（<strong>[[Certolizumab pegol]]</strong>，商品名：<strong>[[希敏佳]]</strong>）是一种独特的人源化抗<strong>[[肿瘤坏死因子α]]</strong>（<strong>[[TNF-α]]</strong>）单克隆抗体。与传统的[[单克隆抗体]]不同，它是由一个不含[[Fc段]]的[[Fab'片段]]与2个40kDa的[[聚乙二醇]]（[[PEG]]）分子共价偶联而成。这种创新的聚乙二醇化结构不仅延长了药物在体内的半衰期，更由于其缺乏[[Fc段]]，使其不具备[[ADCC]]和[[CDC]]效应。最显著的临床特性在于，[[赛妥珠单抗]]几乎不通过胎盘传输，是目前<strong>[[自身免疫性疾病]]</strong>患者（如[[类风湿关节炎]]、[[克罗恩病]]、[[强直性脊柱炎]]等）在妊娠期及哺乳期优先推荐的生物制剂。
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            <div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">[[赛妥珠单抗]]</div>
            <div style="font-size: 0.75em; opacity: 0.85; margin-top: 4px;">[[Certolizumab pegol]] / [[Cimzia]] · 点击展开</div>
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                <div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">靶点：[[TNF-α]] (膜结合型/可溶型)</div>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; width: 45%;">药物类型</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">[[聚乙二醇化Fab'片段]]</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">分子量</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">约 91 kDa</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">给药方式</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[皮下注射]]</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">研发企业</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[UCB]] (优时比)</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">CAS号</th>
                    <td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">428863-50-7</td>
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                    <th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569;">主要适应症</th>
                    <td style="padding: 12px; color: #0f172a;">[[RA]]/[[AS]]/[[PsA]]/[[CD]]</td>
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        [[赛妥珠单抗]]的作用机制体现了抗体工程学的精妙设计，其核心优势源于独特的结构改造：
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        <li style="margin-bottom: 12px;"><strong>TNF-α中和：</strong>Fab'片段能以高亲和力结合可溶型及膜结合型[[TNF-α]]，通过物理阻断其与受体[[TNFR1]]/[[TNFR2]]的结合，迅速抑制炎症因子诱导的免疫级联反应。</li>
        <li style="margin-bottom: 12px;"><strong>消除Fc端效应：</strong>由于不含[[Fc段]]，[[赛妥珠单抗]]在结合细胞表面受体后，不会激活[[补体系统]]（[[CDC]]）或诱导[[NK细胞]]介导的[[ADCC]]作用。这意味着它能抑制炎症，同时减少对靶细胞的直接溶解杀伤，安全性更高。</li>
        <li style="margin-bottom: 12px;"><strong>PEG化的长效性：</strong>40kDa的[[聚乙二醇]]链不仅保护Fab'片段免受酶解，还降低了肾清除率，使其循环半衰期达到约14天，实现了两周一次的便捷给药。</li>
        <li style="margin-bottom: 12px;"><strong>低胎盘转运率：</strong>胎盘转运主要依赖于[[FcRn]]受体。[[赛妥珠单抗]]因无[[Fc段]]，无法与[[FcRn]]结合，临床试验（[[CRIB研究]]）证实其在新生儿及脐带血中的浓度极低，甚至无法检出。</li>
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                <th style="padding: 10px; border: 1px solid #cbd5e1; color: #0f172a; width: 25%;">疾病领域</th>
                <th style="padding: 10px; border: 1px solid #cbd5e1; color: #475569;">适应症</th>
                <th style="padding: 10px; border: 1px solid #cbd5e1; color: #1e40af;">临床价值表现</th>
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                <td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[风湿免疫科]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">[[类风湿关节炎]]/[[强直性脊柱炎]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">显著降低[[DAS28]]评分，改善关节破坏，防止致残。</td>
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                <td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[消化内科]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">[[中重度克罗恩病]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">诱导并维持肠道黏膜愈合，减少瘘管形成及手术需求。</td>
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                <td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[皮肤科]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">[[银屑病]]/[[银屑病关节炎]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">改善[[PASI]]评分，缓解皮损及关节肿痛。</td>
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                <td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[妇产科相关]]</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">备孕/妊娠期风湿病</td>
                <td style="padding: 8px; border: 1px solid #cbd5e1;">唯一在说明书中包含妊娠及哺乳期安全数据的[[TNF抑制剂]]。</td>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">诊疗策略：规范化与特殊人群管理</h2>
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        [[赛妥珠单抗]]的使用应遵循精准医疗原则，平衡药效与感染风险：
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        <li style="margin-bottom: 12px;"><strong>结核与感染筛查：</strong>启动治疗前必须进行[[结核分枝杆菌]]（[[T-SPOT]]）及[[乙肝]]筛查。活动性感染或活动性结核患者禁用。</li>
        <li style="margin-bottom: 12px;"><strong>给药方案：</strong>通常首剂400mg，第2、4周给予400mg作为诱导，随后根据适应症每2周或4周维持给药。</li>
        <li style="margin-bottom: 12px;"><strong>妊娠期策略：</strong>对于病情活跃的妊娠期妇女，[[赛妥珠单抗]]可全孕期使用。新生儿在接种[[卡介苗]]等减毒活疫苗前通常无需特殊等待期（相对于其他需要等待6个月的[[TNF抑制剂]]）。</li>
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    <h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">关键相关概念</h2>
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            <li style="margin-bottom: 8px;"><strong>[[TNF-α]]：</strong>主要的促炎细胞因子，是多种自身免疫性疾病的共同致病因素。</li>
            <li style="margin-bottom: 8px;"><strong>[[阿达木单抗]]/[[英夫利昔单抗]]：</strong>传统全抗体结构的[[TNF抑制剂]]，均具有Fc段。</li>
            <li style="margin-bottom: 8px;"><strong>[[CRIB研究]]：</strong>证明[[赛妥珠单抗]]不通过胎盘传输的核心临床证据。</li>
            <li style="margin-bottom: 8px;"><strong>[[Fab片段]]：</strong>抗体结合抗原的活性部分。</li>
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        <span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献与权威点评</span>
        
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            [1] <strong>Mariette X, et al. (2018).</strong> <em>Lack of placental transfer of certolizumab pegol during pregnancy: results from CRIB, a prospective, postmarketing, multicenter, pharmacokinetic study.</em> <strong>[[Annals of the Rheumatic Diseases]]</strong>.[Academic Review]<br>
            <span style="color: #475569;">[权威点评]：该研究证实了赛妥珠单抗在胎盘转运方面的独特安全性。</span>
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        <p style="margin: 12px 0; border-bottom: 1px solid #e2e8f0; padding-bottom: 10px;">
            [2] <strong>Sandborn WJ, et al. (2007).</strong> <em>Certolizumab pegol for the treatment of Crohn's disease.</em> <strong>[[The New England Journal of Medicine]]</strong>. 357(3):228-238.<br>
            <span style="color: #475569;">[核心价值]：确立了该药在中重度克罗恩病诱导及维持治疗中的里程碑地位。</span>
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            [[赛妥珠单抗]] (Certolizumab pegol) 诊疗生态 · 知识图谱
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">关联靶点</td>
                <td style="padding: 10px 15px; color: #334155;">[[TNF-α]]•[[TNFR1]]•[[TNFR2]]•[[CRP]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">同类/竞争</td>
                <td style="padding: 10px 15px; color: #334155;">[[阿达木单抗]]•[[英夫利昔单抗]]•[[戈利木单抗]]•[[依那西普]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">战略实体</td>
                <td style="padding: 10px 15px; color: #334155;">[[UCB]]•[[FDA]]•[[NMPA]]•[[EULAR]]</td>
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                <td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">研究前沿</td>
                <td style="padding: 10px 15px; color: #334155;">[[非放射学轴性脊柱关节炎的应用]]•[[葡萄膜炎的治疗探索]]•[[抗药抗体对药效的影响监测]]</td>
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