Modulatory Effects on Axonal Function After Intravenous Immunoglobulin Therapy in Chronic Inflammatory Demyelinating Polyneuropathy
Modulatory Effects on Axonal Function After Intravenous Immunoglobulin Therapy in Chronic Inflammatory Demyelinating Polyneuropathy
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DOI：
10.1001/archneurol.2011.137
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发表时间：
2011-07-01
影响因子：
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通讯作者：
Kiernan, Matthew C.
中科院分区：
文献类型：
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作者：
Lin, Cindy Shin-Yi;Krishnan, Arun V.;Kiernan, Matthew C.
目的：探讨静脉注射免疫球蛋白（IVIg）对慢性炎症性脱髓鞘性多神经病变（CIDP）轴突功能的即时和纵向作用机制。设计：前瞻性单中心研究。地点：医院和门诊诊所。受试者：对27例患者进行临床和功能评估、神经传导研究和526项运动兴奋性研究，在输注前和输注后立即进行配对，并进行纵向随访。主要观察指标：在输注前和输注后立即测量轴突兴奋性变量，并与健康对照的匹配研究结果进行比较。结果：患者输注后立即出现阈值降低，强度-持续时间常数显著降低（P = 0.003），去极化适应能力降低（P = 0.04），超极化阈值变化降低（P = 0.003），同时超兴奋性（P = 0.03）和亚兴奋性（P = 0.02）显著降低。相比之下，在疾病对照组中没有变化，证实了IVIg在CIDP患者中的特异性作用。纵向上，变化与临床改善相关（医学研究委员会总评分的平均[SE]增加，2.7 [0.7];P = 0.005）。复合肌动作电位振幅的增加与终末潜伏期的减少相关（相关系数为-0.65;P = 0.02）。此外，这些变化转化为功能评估的改善，通过调整炎症性神经病变病因和治疗评分，显示出与神经兴奋性变量的纵向显著相关（P = 0.01）。结论：本系列研究结果证实了IVIg对CIDP患者轴突功能的调节作用，表明IVIg稳定轴突膜电位，促进轴突恢复。
Objective: To investigate the immediate and longitudinal mechanisms of action of intravenous immunoglobulin (IVIg) on axonal function in chronic inflammatory demyelinating polyneuropathy (CIDP).Design: Prospective single-center study.Setting: Hospitals and outpatient clinics.Participants: Clinical and functional assessment, nerve conduction studies, and 526 motor excitability studies were undertaken in 27 patients, matched before and immediately after infusion and followed up longitudinally.Main Outcome Measures: Axonal excitability variables were measured before and immediately after infusion and compared with matched studies and findings in healthy controls.Results: Immediately after infusion, patients demonstrated decreased threshold, with significant reduction in strength-duration time constant (P = .003), reduction in accommodation to depolarization (P = .04), and reduced threshold change during hyperpolarization (P = .003), accompanied by significant decreases in superexcitability (P = .03) and subexcitability (P = .02). In contrast, changes were absent in disease controls, confirming a specific IVIg action in CIDP patients. Longitudinally, changes correlated with clinical improvement (mean [SE] increase in the Medical Research Council sum score, 2.7 [0.7]; P = .005). Increased compound muscle action potential amplitude was associated with reduction in terminal latency (correlation coefficient, -0.65; P = .02). In addition, these changes translated into improvement in functional assessment with the adjusted Inflammatory Neuropathy Cause and Treatment score, which demonstrated a significant correlation with nerve excitability variables longitudinally (P = .01).Conclusions: Findings from the present series establish a modulatory effect of IVIg on axonal function in CIDP patients, suggesting that IVIg stabilizes axonal membrane potential and promotes axonal recovery.