Systematic reviews of treatment for inflammatory clemyelinating neuropathy
Systematic reviews of treatment for inflammatory clemyelinating neuropathy
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DOI：
10.1046/j.1469-7580.2002.00041.x
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发表时间：
2002-04-01
影响因子：
2.4
通讯作者：
Hughes, RAC
中科院分区：
文献类型：
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作者：
Hughes, RAC
本文综述了科克伦系统评价在格林-巴利综合征（GBS）、慢性炎性脱髓鞘性多神经根神经病（CIDP）、多灶性运动神经病（MMN）和副蛋白相关脱髓鞘性神经病随机对照试验中的应用进展。针对髓鞘和轴膜糖脂和蛋白质的抗体的发现尚未取代治疗试验所基于的临床病理学分类。系统性综述已经证实了血浆置换（PE）和静脉注射免疫球蛋白（IVIg）的等效性以及类固醇在GBS中缺乏疗效。系统评价也支持类固醇、PE和IVIg在CIDP中的价值，但随机对照试验仅显示IVIg在MMN中的益处。小型试验显示PE或IVIG的短期益处，但有关副蛋白血症脱髓鞘神经病治疗效果的证据很少。在任何这些情况下，都缺乏免疫抑制剂的良好质量控制试验。随着治疗试验数量的增加，科克伦系统评价将成为一个越来越有价值的资源，用于总结随机对照试验的证据，以作为临床实践的基础。它们已经表明现有证据基础存在重大缺陷。
This review describes the progress made in preparing Cochrane systematic reviews of randomized controlled trials for Guillain-Barre syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), multifocal motor neuropathy (MMN) and the demyelinating neuropathies associated with paraproteins. The discovery of antibodies against myelin and axolemmal glycolipids and proteins has not yet replaced the clinicopathological classification on which treatment trials have been based. Systematic reviews have endorsed the equivalence of plasma exchange (PE) and intravenous immunoglobulin (IVIg) and the lack of efficacy of steroids in GBS. Systematic reviews have also endorsed the value of steroids, PE and IVIg in CIDP but randomized controlled trials have only shown benefit from IVIg in MMN. There is a paucity of evidence concerning the efficacy of treatments in paraproteinaemic demyelinating neuropathy apartment from small trials showing short-term benefit from PE or IVIg. There is a lack of good quality controlled trials of immunosuppressive agents in any of these conditions. As the number of treatment trials increases, Cochrane systematic reviews will be an increasingly valuable resource for summarizing the evidence from randomised controlled trials on which to base clinical practice. They already demonstrate major deficiencies in the existing evidence base.