感染后炎性疾病:基于前瞻性随访的患者亚型  

Postinfectious inflammatory disorders: Subgroups based on prospective follow-up

作　　者：Marchioni E. Ravaglia S. Piccolo G. 方伯言 

机构地区：[1]Institute of Neurology IRCCS C. Mondino, University of Pavia, Via Mondino 2, 27100 Pavia, Italy

出　　处：《世界核心医学期刊文摘（神经病学分册）》2006年第3期28-29,共2页Digest of the World Core Medical Journals:Clinical Neurology

摘　　要：Background: Acute disseminated encephalomyelitis (AD- EM)refers to a monophasic acute multifocal inflammatory CNS disease. However, both relapsing and site-restricted variants, possibly associated with peripheral nervous system (PNS) involvement, are also observed, and a systematic classifi cation is lacking. Objective: To describe a cohort of postinfectious ADEM patien ts, to propose a classification based on clinical and instrumental features, and to identify subgroups of patients with different prognostic factors. Methods: I npatients of a Neurologic and Infectious Disease Clinic affected by postinfectio us CNS syndrome consecutively admitted over 5 years were studied. Results: Of 75 patients enrolled, 60 fulfilled criteria for ADEM after follow-up lasting from 24 months to 7 years. Based on lesion distribution, patients were classified as encephalitis (20%),myelitis (23.3%), encephalomyelitis (13.3%), encephalomye loradiculoneuritis (26.7%), and myeloradiculoneuritis (16.7%). Thirty patients (50%) had a favorable outcome. Fifteen patients (25%) showed a relapsing cour se. Poor outcome was related with older age at onset, female gender, elevated CS F proteins, and spinal cord and PNS involvement. All but two patients received h igh-dose steroids as first-line treatment, with a positive response in 39 (67 %). Ten of 19 nonresponders (53%)benefited from high-dose IV immunoglobulin; 9 of 10 had PNS involvement. The data were not controlled. Conclusions: A high p revalence of “atypical variants”was found in this series, with site-restricte d damage or additional peripheral nervous system (PNS) involvement. Prognosis an d response to steroids were generally good, except for some patient subgroups. I n patients with PNS involvement and steroid failure, a favorable effect of IV im munoglobulin was observed.Background: Acute disseminated encephalomyelitis (AD- EM)refers to a monophasic acute multifocal inflammatory CNS disease. However, both relapsing and site-restricted variants, possibly associated with peripheral nervous system (PNS) involvement, are also observed, and a systematic classifi cation is lacking. Objective: To describe a cohort of postinfectious ADEM patien ts, to propose a classification based on clinical and instrumental features, and to identify subgroups of patients with different prognostic factors. Methods: I npatients of a Neurologic and Infectious Disease Clinic affected by postinfectio us CNS syndrome consecutively admitted over 5 years were studied. Results: Of 75 patients enrolled, 60 fulfilled criteria for ADEM after follow-up lasting from 24 months to 7 years. Based on lesion distribution, patients were classified as encephalitis (20%),myelitis (23.3%), encephalomyelitis (13.3%), encephalomye loradiculoneuritis (26.7%), and myeloradiculoneuritis (16.7%). Thirty patients (50%) had a favorable outcome. Fifteen patients (25%) showed a relapsing cour se. Poor outcome was related with older age at onset, female gender, elevated CS F proteins, and spinal cord and PNS involvement. All but two patients received h igh-dose steroids as first-line treatment, with a positive response in 39 (67 %). Ten of 19 nonresponders (53%)benefited from high-dose IV immunoglobulin; 9 of 10 had PNS involvement. The data were not controlled. Conclusions: A high p revalence of “atypical variants”was found in this series, with site-restricte d damage or additional peripheral nervous system (PNS) involvement. Prognosis an d response to steroids were generally good, except for some patient subgroups. I n patients with PNS involvement and steroid failure, a favorable effect of IV im munoglobulin was observed.

关 键 词：炎性疾病 神经根神经炎 脑脊髓炎 感染性疾病 免疫球蛋白 多灶性 预后良好 仪器检查 诊断标准 发病 

分 类 号：R742.9[医药卫生—神经病学与精神病学]