多发性硬化症时体液病理改变与治疗性血浆置换疗效间的关系  

Relation between humoral pathological chan- ges in multiple sclerosis and response to therapeutic plasma exchange

作　　者：Keegan M. Kinig F. mCclelland R. C. F.Lucchinetti 郭俊 

机构地区：[1]Dr.Department of Neurology,Mayo Clin-ic,College of Medicine, Rochester, MN 55905, United States

出　　处：《世界核心医学期刊文摘（神经病学分册）》2005年第12期2-3,共2页Digest of the World Core Medical Journals:Clinical Neurology

摘　　要：Early, active multiple sclerosis lesions show four immunopathological patterns of demyelination. Although these patterns differ between patients, multiple active lesions from a given patient have an identical pattern, which suggests pathogenic heterogeneity. Therapeutic plasma exchange (TPE) has been successfully used to treat fulminant demyelinating attacks unresponsive to steroids. We postulated that patients with pattern II would be more likely to improve after TPE than those with other patterns since pattern II lesions are distinguished by prominent immunoglobulin deposition and complement activation. We retrospectively studied 19 patients treated with TPE for an attack of fulminant CNS inflammatory demyelinating disease. All patients with pattern II (n=10), but none with pattern I (n=3) or pattern III (n=6), achieved moderate to substantial functional neurologicalimprovement after TPE (p < 0.0001). Patients with multiple sclerosis with pattern II pathology are more likely to respond favourably to TPE than are patients with patterns I or III.Early, active multiple sclerosis lesions show four immunopathological patterns of demyelination. Although these patterns differ between patients, multiple active lesions from a given patient have an identical pattern, which suggests pathogenic heterogeneity. Therapeutic plasma exchange (TPE) has been successfully used to treat fulminant demyelinating attacks unresponsive to steroids. We postulated that patients with pattern II would be more likely to improve after TPE than those with other patterns since pattern II lesions are distinguished by prominent immunoglobulin deposition and complement activation. We retrospectively studied 19 patients treated with TPE for an attack of fulminant CNS inflammatory demyelinating disease. All patients with pattern II (n=10), but none with pattern I (n=3) or pattern III (n=6), achieved moderate to substantial functional neurologicalimprovement after TPE (p < 0.0001). Patients with multiple sclerosis with pattern II pathology are more likely to respond favourably to TPE than are patients with patterns I or III.

关 键 词：多发性硬化症 治疗性血浆置换 脱髓鞘性疾病 免疫病理 中枢神经系统 免疫球蛋白 暴发性 补体激活 异质性 

分 类 号：R744.51[医药卫生—神经病学与精神病学]