Plasma exchange and chlorambucil in polyneuropathy associated with monoclonal IgM gammopathy. IgM-associated Polyneuropathy Study Group.
Plasma exchange and chlorambucil in polyneuropathy associated with monoclonal IgM gammopathy. IgM-associated Polyneuropathy Study Group.
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血浆置换和苯丁酸氮芥治疗与单克隆 IgM 丙种球蛋白病相关的多发性神经病。
DOI：
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发表时间：
1995
影响因子：
11
通讯作者：
J. Brouet
中科院分区：
文献类型：
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作者：
É. Oksenhendler;S. Chevret;J. Léger;J. Louboutin;A. Bussel;J. Brouet
该研究比较了氯霉素单用与氯霉素联合血浆置换治疗单克隆IgM相关多发性神经病变的疗效。在一项比较开放试验中，44名患者被前瞻性随机分配，在治疗的前4个月接受0.1 mg/kg/天的口服氯苯，持续12个月，或接受氯苯与15个疗程的血浆置换。他们通过神经病变残疾评分和神经传导研究进行评估。两个治疗组之间没有发现差异。氯霉素组平均神经病变失能评分较基线提高2.1分（21.0 ~ 18.9），氯霉素+血浆交换组平均神经病变失能评分较基线提高1.8分（20.4 ~ 18.6）（P = 0.70）。氯霉素组运动神经平均传导速度由20.0下降至18.2 m/s，氯霉素+血浆交换组运动神经平均传导速度由20.5上升至22.5 m/s （P = 0.51）。两组患者神经病变功能障碍的感觉评分均有轻微改善（从10.5到8.3）（P = 0.01）。在研究结束时，根据自我评估，15名患者（8名来自氯苯bucil组，7名来自氯苯bucil +血浆交换组）报告临床改善，而15名患者（8名来自氯苯bucil组，7名来自氯苯bucil +血浆交换组）报告临床恶化。其他患者的神经病变保持稳定。因此，血浆置换似乎在治疗与单克隆IgM相关的多神经病变方面没有额外的益处。
The study compared chlorambucil alone with chlorambucil in combination with plasma exchange in patients with polyneuropathy associated with monoclonal IgM. Forty four patients were prospectively randomly assigned, in a comparative open trial, to receive either 0.1 mg/kg/day chlorambucil orally, for 12 months or chlorambucil associated with 15 courses of plasma exchange, during the first four months of treatment. They were evaluated by a neuropathy disability score and nerve conduction studies. No difference was found between the two treatment groups. The average neuropathy disability score improved by 2.1 points from baseline (21.0 to 18.9) in the chlorambucil group and by 1.8 points (20.4 to 18.6) in the chlorambucil + plasma exchange group (P = 0.70). The mean motor nerve conduction velocity decreased from 20.0 to 18.2 m/s in the chlorambucil group and increased from 20.5 to 22.5 m/s in the chlorambucil + plasma exchange group (P = 0.51). A slight improvement of the sensory component of the neuropathy disability score (from 10.5 to 8.3) was noted in both groups (P = 0.01). At the end of the study and according to self evaluation, 15 patients--eight from the chlorambucil group and seven from the chlorambucil + plasma exchange group--reported clinical improvement, whereas 15--eight from the chlorambucil group and seven from the chlorambucil + plasma exchange group--reported clinical worsening. Neuropathy remained stable in the others. Thus plasma exchange seemed to confer no additional benefit in the treatment of polyneuropathy associated with monoclonal IgM.