Intravenous Methylprednisolone Versus Therapeutic Plasma Exchange for Treatment of Anti-N-Methyl-D-Aspartate Receptor Antibody Encephalitis: A Retrospective Review
Intravenous Methylprednisolone Versus Therapeutic Plasma Exchange for Treatment of Anti-N-Methyl-D-Aspartate Receptor Antibody Encephalitis: A Retrospective Review
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DOI：
10.1002/jca.21363
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发表时间：
2015-08-01
影响因子：
1.5
通讯作者：
Graves, Donna
中科院分区：
文献类型：
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作者：
DeSena, Allen D.;Noland, Daniel K.;Graves, Donna
前言：抗N-甲基-d-天冬氨酸（NMDA）受体抗体脑炎是一种日益被认可的自身免疫性脑炎。常规治疗包括诸如皮质类固醇、静脉内免疫球蛋白（IVIg）和/或治疗性血浆置换（TPE）的疗法。尽管TPE经常用于治疗抗NMDA受体抗体脑炎，但美国血液分离学会仅给予其III类推荐。在肿瘤阴性患者中早期给予免疫治疗可能有助于更快的恢复，但目前尚不清楚TPE是否上级类固醇和/或IVIG。研究方法：我们回顾性评估了14例接受类固醇和TPE的患者中的10例，采用改良的兰金评分，并主观评估了所有14例患者的最大持续改善点。结果如下：在同一住院期间在我们机构接受类固醇和TPE的患者中（14例患者中仅10例），TPE后7/10例患者的改良兰金评分改善，而类固醇治疗后3/10例患者改善。该组中类固醇治疗后的平均改良兰金评分改善为-0.1，而TPE治疗后为0.4。根据对所有14名患者进行评估的主观图表审查分析，9/14名患者在第三次交换后立即出现最大的持续改善，而只有2/14名患者在类固醇治疗后立即出现显着获益。结论：这是令人信服的初步数据，表明皮质类固醇可能不如类固醇后TPE有效。考虑到时间敏感性治疗的重要性，更正式的研究可能会阐明抗NMDA受体抗体脑炎的理想一线治疗。临床单采30：212-216，2015年。(c)2015 Wiley Periodicals，Inc.
Introduction: Anti-N-methyl-d-aspartate (NMDA) receptor antibody encephalitis is an increasingly recognized form of autoimmune encephalitis. Conventional treatments include therapies such as corticosteroids, intravenous immunoglobulin (IVIg), and/or therapeutic plasma exchange (TPE). Although TPE is regularly used for treatment of anti-NMDA receptor antibody encephalitis, the American Society for Apheresis has given it a category III recommendation only. Earlier administered immunotherapies in tumor-negative patients may facilitate faster recoveries, but it remains unclear whether or not TPE is superior to steroids and/or IVIG. Methods: We retrospectively evaluated 10 of 14 patients that received steroids and TPE with modified Rankin scores and subjectively assessed the point of largest sustained improvement in all 14 patients. Results: In the patients that received both steroids and TPE at our institution during the same hospitalization (only 10 of 14 patients), 7/10 patients after TPE had improved with the modified Rankin score versus 3/10 patients after steroids. The average modified Rankin score improvement after steroids in this group was -0.1 as compared with 0.4 after TPE. Based on subjective chart review analysis during which all 14 patients were assessed, the largest sustained improvement occurred immediately following the third-fifth exchange in 9/14 patients, whereas only 2/14 patients appeared to have had significant benefit immediately following steroids. Conclusions: This is compelling preliminary data that suggests that corticosteroids may not be as effective compared to steroids followed by TPE. Given the importance of time-sensitive treatment, more formal studies may illuminate the ideal first-line treatment for anti-NMDA receptor antibody encephalitis. J. Clin. Apheresis 30:212-216, 2015. (c) 2015 Wiley Periodicals, Inc.