免疫吸附治疗视神经脊髓炎谱系病患者的临床分析  

The clinical analysis of immunoadsorption on neuromyelitis optica spectrum disorder

作　　者：丁霞 张寅[1] 黄琪 龚勇[1] 刘婧 王冬雪[1] 周衡 张星虎[2] 周亦伦[1] DING Xia;ZHANG Yin;HUANG Qi;GONG Yong;LIU Jing;WANG Dongxue;ZHOU Heng;ZHANG Xinghu;ZHOU Yilun(不详;Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;Department of Nephrology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京天坛医院肾内科,100071 [2]首都医科大学附属北京天坛医院神经内科,100071

出　　处：《中国神经免疫学和神经病学杂志》2023年第6期395-399,共5页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨免疫吸附对视神经脊髓炎谱系病(neuromyelitis optica spectrum disorder,NMOSD)急性期的治疗效果。方法对15例对大剂量糖皮质激素治疗反应不佳的NMOSD急性发作期患者,进行免疫吸附治疗5次,比较治疗前后的扩展残疾评分量表(expanded disability status scale,EDSS)、视力分层、水通道蛋白4(aquaporin 4,AQP4)抗体水平、免疫球蛋白及补体变化。结果15例患者免疫吸附治疗后相对于治疗前的EDSS评分〔4.0(3.0,6.0)比4.5(3.0,6.5),t=2.640,P=0.008〕、AQP4抗体水平〔(16.27±22.40)u/mL比(45.24±32.97)u/mL,t=4.011,P=0.002〕均显著降低。10例患者共15只眼出现视神经炎,治疗后视力均较治疗前显著改善〔视力分层4.0(3.0,5.0)比5.0(3.0,7.0),t=2.872,P=0.007〕。免疫吸附治疗后较治疗前补体C3水平〔(0.53±0.20)g/L比(1.02±0.22)g/L,t=6.588,P=0.001〕、补体C4水平〔(0.12±0.34)g/L比(0.20±0.06)g/L,t=5.597,P=0.001〕均显著下降。15例患者中5例出现轻度不良反应,4例患者在免疫吸附治疗3次后出现纤维蛋白原降低,经输注纤维蛋白原1 g 1次后改善;1例患者首次治疗中曾发生一过性低血压,补液治疗后缓解;无重度不良事件发生。结论免疫吸附治疗可有效改善NMOSD患者临床神经功能及视力,降低AQP4抗体水平。免疫吸附治疗安全性良好。Objective To evaluate the therapeutic efficacy of immunoadsorption on patients with neuromyelitis optica spectrum disorder(NMOSD)duing the acute phase.Methods Fifteen NMOSD patients who did not respond well to high-dose intravenous corticosteroid duing the acute phase were enrolled.Five immunoadsorption treatments were performed.The changes of expanded disability status scale(EDSS),visual acuity,aquaporin-4(AQP4)antibody level,immunoglobulin,and complement before and after treatment were analyzed.Results EDSS improved from 4.5(3.0,6.5)to 4.0(3.0,6.0)(t=2.640,P=0.008)after immunoadsorption treatments.The level of AQP4 antibody decreased from(45.24±32.97)u/mL to(16.27±22.40)u/mL(t=4.011,P=0.002).The visual acuity stratification value of 15 affected eyes of 10 patients also improved significantly from 5.0(3.0,7.0)to 4.0(3.0,5.0)(t=2.872,P=0.007).Complement C3[(1.02±0.22)g/L vs.(0.53±0.20)g/L,t=6.588,P=0.001]and complement C4[(0.20±0.06)g/L vs.(0.12±0.34)g/L,t=5.597,P=0.001]were also decreased significantly after immunoadsorption treatments.Five patients experienced mild adverse reactions,four of which showed fibrinogen reduction after three treatments,and restored quickly after fibrinogen 1 g infusiononce.One patient experienced transient hypotension during the first treatment,and relieved after rehydration.No serious adverse events occurred.Conclusions Immunoadsorption can effectively improve the clinical function and visual acuity of patients with NMOSD,and reduce the level of AQP4 antibody.Meanwhile,immunoadsorption has good safety.

关 键 词：免疫吸附 视神经脊髓炎谱系病 水通道蛋白4抗体 

分 类 号：R744.52[医药卫生—神经病学与精神病学]