Bickerstaff脑干脑炎和Miller Fisher综合征免疫调节治疗疗效的对比研究  

The effectiveness of immunomodulating treatment on Bickerstaff's brainstem encephalitis and Miller Fisher syndrome

作　　者：王志丽[1] 谭利明[1] 赵鑫[1] 肖艳桥 仇东旭[1] 杨利[1] 

机构地区：[1]中南大学湘雅二医院神经内科,湖南长沙410011

出　　处：《中风与神经疾病杂志》2015年第5期441-445,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨免疫调节治疗在Bickerstaff脑干脑炎（BBE）和Miller Fisher综合征（MFS）中的疗效。方法回顾性分析湘雅二医院和湘雅医院2003~2013年符合BBE（32例）和MFS（67例）诊断标准的患者临床资料,比较免疫调节治疗对两组患者症状的改善及预后的影响。结果与对照组对比,IVIg联合激素治疗可以加快BBE患者意识障碍的恢复（P〈0.05）;IVIg、激素单独治疗在BBE患者意识障碍、眼外肌麻痹及共济失调症状的开始改善时间上无明显差异（P〉0.05）。各免疫调节治疗措施与对照组相比,对MFS患者眼外肌麻痹和共济失调症状的恢复均无明显加速作用（P〉0.05）。两组平均随访时间均〉1 y,未见复发病例,绝大多数的BBE（66%）和MFS（98%）患者症状完全缓解,9例BBE患者死亡。结论 IVIg联合激素治疗可加快BBE患者意识障碍的恢复,改善早期出现意识障碍患者的预后。免疫治疗措施对MFS患者疾病病程及预后无明显影响,可能与该病的具有较好的自然病程有关。Objective To judge the effectiveness of immunomodulating treatment on Bickerstaff＇ s brainstem en- cephalitis and Miller Fisher syndrome. Methods We reviewed medical records of 32 BBE patients and 67 MFS patients diagnosed by strict criteria, enrolled at the second Xiangya Hospital and Xiangya Hospital in Changsha, China between 2003 and 2013. Results In our study,the Kaplan-Meier curves for the periods between the onset of impaired consciousness and the start of alleviation in the symptom showed that BBE patients were more likely to have faster alleviation of impaired con- sciousness when treated with combination of IVIg and steroids than control （p 〈 0.05 ）. There were no significant differ- ences among IVIg, PE, steroids, the combinations of IVIg with steroids and control group in the start of the alleviation and the disappearance of ophthalmoplegia and ataxia in MFS patients （ p 〉 0.05 ）. Both outcomes generally were good, by 1 year after disease onset 21（66% ） of the 32 BBE patients and 66 （98%） of the 67 MFS patients showed complete remission with no residual symptoms. In addition ,9 BBE patients died. Conclusion IVIg combination with steroids woud be recom- mended being used in BBE patients since data have suggested a slightly hastening in impaired consciousness recovery. Im- munotherapy seems not influenced MFS patients＇ outcoms, presumably because of good natural recoveries.

关 键 词：脑炎 BICKERSTAFF脑干脑炎 MILLER FISHER综合征 吉兰-巴雷综合征 免疫调节治疗 

分 类 号：R774.5[医药卫生—眼科]