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| 免疫吸附治疗急性重症/难治性吉兰-巴雷综合征患者的临床疗效分析 |
| The clinical analysis of immunoadsorption therapy in acute severe/refractory Guillain⁃Barré syndromeYang Yishu1, Tuo Houzhen1, Guo Wang2, Zhao Yingying1, Yang Yi1, Chen Zhichao1, Chen Ruiling1 |
| 投稿时间：2025-02-26 修订日期：2025-02-26 |
| DOI： |
| 中文关键词: 免疫吸附 重症/难治性吉兰-巴雷综合征 抗神经节苷脂抗体 蛋白A免疫吸附 |
| 英文关键词: immunoadsorption severe/refractory Guillain⁃Barré syndrome anti ganglioside antibody protein A immunoadsorption |
| 基金项目:2023年度医药健康产业发展项目(JX2023YJ021) |
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| 中文摘要: |
| 目的 评估和探讨对于常规一线免疫治疗方案效果不佳的急性重症/难治性吉兰-巴雷综合征患者,应用免疫吸附(immunoadsorption, IA)治疗的整体疗效及安全性,为神经系统自身免疫性疾病的治疗提供新的临床指导。 方法 选择2021年11月-2024年11月首都医科大学附属北京友谊医院神经内科病房收治的6例急性重症/难治性吉兰-巴雷综合征患者,均为常规一线免疫治疗效果不佳,后续在我院肾内科的协助下启动了蛋白A免疫吸附治疗,回顾性分析其临床疗效、免疫球蛋白和补体变化情况以及不良反应。 结果 6例患者IA治疗后临床症状体征均有改善,包括肌力、自主呼吸功能、眼球运动和意识状态等不同方面；6例患者其IgG水平在首次IA治疗后均显著下降,IgM和IgA,补体C3和C4亦有不同程度下降；6例患者仅2例有轻微不良反应,1例首次IA治疗时有短暂意识丧失,可能与情绪紧张有关,不除外首次使用综合征,后续治疗无特殊不适；另1例有低分子肝素使用相关的血小板计数减低,停药后好转。 结论 急性重症/难治性吉兰-巴雷综合征患者应用常规一线免疫治疗未达满意疗效,继以IA治疗可进一步改善患者神经功能,提高生存质量,且安全性良好,值得临床推广。 |
| 英文摘要: |
| Objective To evaluate and explore the overall efficacy and safety of immunoadsorption (IA) technology in patients with acute severe/refractory Guillain⁃Barré syndrome who have poor response to conventional first-line immunotherapy regimens, and to provide new clinical guidance for the treatment of autoimmune neurological diseases. Methods In the neurology ward of Beijing Friendship Hospital affiliated to Capital Medical University from November 2021 to November 2024, 6 patients with acute severe/refractory Guillain⁃Barré syndrome were enrolled who did not respond well to conventional first-line immunotherapy and subsequently protein A immunoadsorption therapy was initiated with the assistance of the nephrology department of our hospital. The clinical efficacy, changes in immunoglobulin and complement, and adverse reactions were retrospectively analyzed. Results After IA treatment, clinical symptoms and signs improved in all 6 patients, including muscle strength, spontaneous breathing function, eye movement, and consciousness status. The IgG levels of 6 patients significantly decreased after the first IA treatment, and IgM and IgA, complement C3 and C4 also decreased to varying degrees. Among the 6 patients, only 2 had mild adverse reactions, one case had a brief loss of consciousness during the first IA treatment, which may be related to emotional tension, and this does not rule out the possibility of first-time use syndrome, there were no special discomforts during subsequent treatment; Another case had a decrease in platelet count related to the use of low molecular weight heparin, which recoverd after discontinuation of the medication. Conclusion In patients with acute severe/refractory Guillain⁃Barré syndrome who had not achieved satisfactory therapeutic effects by conventional first-line immunotherapy, continuing with IA treatment can further improve patients’ neurological function, enhance their quality of life, and has good safety, which is worthy of clinical promotion. |
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