Nerve ultrasound may help predicting response to immune treatment in chronic inflammatory demyelinating polyradiculoneuropathy
Nerve ultrasound may help predicting response to immune treatment in chronic inflammatory demyelinating polyradiculoneuropathy
复制标题
神经超声可能有助于预测慢性炎症性脱髓鞘性多发性神经根神经病对免疫治疗的反应
DOI：
10.1007/s10072-022-05882-7
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发表时间：
2022-01-21
影响因子：
3.3
通讯作者：
Liu, Mingsheng
中科院分区：
文献类型：
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作者：
Niu, Jingwen;Zhang, Lei;Liu, Mingsheng
背景神经超声已被证明是诊断慢性炎症性脱髓鞘多神经根神经病(CIDP)的准确工具。然而，它在指导治疗方面的价值还没有得到很好的评价。本研究旨在探讨神经超声及其变化趋势能否预测CIDP对免疫治疗的反应。方法前瞻性收集89例未接受治疗的CIDP患者，给予激素和/或静脉注射免疫球蛋白(IVIG)治疗。所有患者治疗前均对正中神经和尺神经进行超声和电生理检查，并对45例患者进行随访。结果在CSA正常或中度增大的患者中，激素治疗的有效率(95%)显著高于静脉注射丙种球蛋白(70%)(P= 0.001)，而在CSA明显增大的患者中，激素治疗的有效率(84%)与静脉注射丙种球蛋白(75%)的有效率(P= 0.653)无显著差异。15例患者术后CSA下降，大部分患者IVIG和激素反应良好(83%)，不需要免疫抑制治疗(82%)。结论神经超声检查有助于指导CIDP患者的治疗策略。CSA正常或中度扩大的患者对类固醇的反应可能比对IVIG更好。治疗后CsA的下降也可能预示着预后的改善。
BackgroundsNerve ultrasound has been proven to be an accurate tool in diagnosing chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). However, its value in guiding treatment has not been well evaluated. The aim of this study was to explore whether nerve ultrasound and its changing trend could predict the response to immune treatment in CIDP.MethodsEighty-nine therapy-naive CIDP patients were recruited prospectively and treated with steroids and/or intravenous immunoglobulin (IVIG). Ultrasonographic and electrophysiological studies were performed on the median and ulnar nerves before treatment in all patients and followed up in 45 patients. The cross-sectional area (CSA) was measured at ten sites on both the median and ulnar nerves.ResultsThe response rate to steroids (95%) was significantly higher than that to IVIG (70%) (P= 0.001) in patients with normal or moderately enlarged CSA, while there was no significant difference in the response rate between steroid therapy (84%) and IVIG (75%) (P= 0.653) in patients with markedly enlarged CSA. CSAs decreased in 15 patients during follow-up, most of whom had good IVIG and steroid responses (83%) and no need for immune suppressant treatment (82%).ConclusionsNerve ultrasonography could help guide treatment strategies in patients with CIDP. Patients with normal or moderately enlarged CSA may respond better to steroids than to IVIG. The decrease in CSA after treatment may also indicate better prognosis.