Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange.
Treatment of acute relapses in neuromyelitis optica: Steroids alone versus steroids plus plasma exchange.
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DOI：
10.1177/1352458515581438
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发表时间：
2016-02
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影响因子：
--
通讯作者：
Levy M
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文献类型：
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作者：
Abboud H;Petrak A;Mealy M;Sasidharan S;Siddique L;Levy M
虽然在严重的视神经肌萎缩症（NMO）发作中加入血浆置换（PLEX）是类固醇耐药病例的常见做法，但这种策略的益处尚未被量化。本文的目的是比较大剂量静脉注射甲基强的松龙（IVMP）与IVMP+PLEX治疗急性NMO复发的疗效。我们对约翰霍普金斯医院最近收治的83例NMO患者进行了回顾性分析，分别接受IVMP单独治疗和IVMP+PLEX治疗（对于类固醇耐药病例）。在基线、就诊、出院和随访时计算扩展残疾状态量表（EDSS）评分。18例NMO复发（16例患者，87%为女性，复发时平均年龄：33.9±23.8，中位基线EDSS 2.5）接受IVMP单独治疗，65例复发（43例患者，95%为女性，复发时平均年龄：43.8±15.7，中位基线EDSS 5.75）接受IVMP + PLEX治疗。65%的IVMP + PLEX患者在随访时达到等于或低于其基线的EDSS，而仅35%的IVMP患者在随访时达到其基线EDSS（比值比=3.36，95% CI 1.0657至10.6004，p = 0.0386）。PLEX在改善复发时接受预防性免疫抑制药物治疗的患者的EDSS方面更有效。与单独使用IVMP相比，PLEX+IVMP更有可能改善NMO复发后的EDSS，尤其是在服用预防性药物的患者中。
Although adding plasma exchange (PLEX) to steroids in severe neuromyelitis optica (NMO) attacks is common practice in steroid-resistant cases, the benefit of this strategy has not been previously quantified. The objective of this paper is to compare the efficacy of high-dose intravenous methylprednisolone (IVMP) versus IVMP+PLEX in treatment of acute NMO relapses. We conducted a retrospective review of the last 83 NMO admissions to the Johns Hopkins Hospital treated with IVMP alone versus IVMP+PLEX (for steroid-resistant cases). Extended Disability Status Scale (EDSS) score was calculated at baseline, at presentation, at discharge, and on follow-up. Eighteen NMO relapses (16 patients, 87% female, mean age at relapse: 33.9±23.8, median baseline EDSS 2.5) were treated with IVMP alone and 65 relapses (43 patients, 95% female, mean age at relapse: 43.8±15.7, median baseline EDSS 5.75) were treated with IVMP + PLEX. Sixty-five percent of IVMP + PLEX patients achieved an EDSS equal or below their baseline at follow-up while only 35% of the IVMP-only patients achieved their baseline EDSS on follow-up (odds ratio=3.36, 95% CI 1.0657 to 10.6004, p = 0.0386). PLEX was more effective in improving EDSS in patients on preventive immunosuppressive medications at time of relapse. PLEX+IVMP are more likely to improve EDSS after NMO relapses compared to IVMP alone, especially in patients taking preventive medications.