Kubori T, Mezaki T, Kaji R, Kimura J, Hamaguchi K, Hirayama K, Kanazawa I, Miyatake T, Mannen T, Kowa H, Yanagisawa N, Goto I, Osame M, Kanda M, Tashiro K, Baba M, Kuroiwa Y, Nagatomo H, Mitsuma T, Shigeta Y, Saida T, Nakajima K, Kawamura J, Murai Y, Kiuchi T
Department of Neurology, Faculty of Medicine, Kyoto University, Japan.
No To Shinkei. 1999 Feb;51(2):127-35.
To explore the optimum dose of intravenous immunoglobulin (i.v.Ig) for treating patients with chronic inflammatory demyelinating polyrneuropathy and multifocal motor neuropathy, we compared the usefulness of i.v.Ig among 3 treatment doses. Fifty-nine patients were randomly divided into three treatment dosage groups: 20 patients for Group I using 50 mg/kg/day x 5 days, 19 patients Group II using 200 mg/kg/day x 5 days, and 20 patients Group III using 400 mg/kg/day x 5 days. We assessed clinically and electrophysiologically the effectiveness of the treatment at 5 weeks after the initial infusion. For patients in Group I and II who had not improved (or worsened) with the first treatment, we gave a one-step larger dose in the second treatment (i.e. 200 mg/kg/day x 5 days for those who had been given 50 mg/kg/day x 5 days, 400 mg/kg/day x 5 days for those who had been given 200 mg/kg/day x 5 days) after more than 9 weeks. We found that 15% of the patients in Group I, 21% in Group II and 60% in Group III improved dose-dependently with the first intravenous immunoglobulin treatment. Seven (47%) of 16 patients in Group I and 4 (40%) of 11 patients in Group II improved after the second treatment with larger doses. Adverse reactions including chill sensation, fever, skin eruption and increase in blood GOT and GPT levels were transient and mild. One patient in Group III developed left hemiparesis showing the small infarction in the right thalamus during the course of the treatment, but the symptom was mild. In conclusion, the high-dose intravenous immunoglobulin therapy (400 mg/kg/day x 5 days) is useful for treating patients with CIDP and MMN, although care must be taken of the risk of causing cerebral infarctions.
为探讨静脉注射免疫球蛋白（i.v.Ig）治疗慢性炎症性脱髓鞘性多发性神经病和多灶性运动神经病患者的最佳剂量，我们比较了3种治疗剂量的i.v.Ig的有效性。59例患者被随机分为3个治疗剂量组：第I组20例，使用50mg/kg/天×5天；第II组19例，使用200mg/kg/天×5天；第III组20例，使用400mg/kg/天×5天。在首次输注后5周，我们从临床和电生理方面评估了治疗效果。对于第I组和第II组中首次治疗后未改善（或病情恶化）的患者，在9周后进行第二次治疗时给予剂量大一档的治疗（即，接受过50mg/kg/天×5天治疗的患者给予200mg/kg/天×5天，接受过200mg/kg/天×5天治疗的患者给予400mg/kg/天×5天）。我们发现，第I组15%的患者、第II组21%的患者和第III组60%的患者在首次静脉注射免疫球蛋白治疗后呈剂量依赖性改善。第I组16例患者中有7例（47%）、第II组11例患者中有4例（40%）在接受更大剂量的第二次治疗后病情改善。包括寒战、发热、皮疹以及血液谷草转氨酶和谷丙转氨酶水平升高在内的不良反应短暂且轻微。第III组有1例患者在治疗过程中出现左侧偏瘫，右侧丘脑显示小梗死灶，但症状较轻。总之，高剂量静脉注射免疫球蛋白疗法（400mg/kg/天×5天）对治疗慢性炎症性脱髓鞘性多发性神经病和多灶性运动神经病患者有效，尽管必须注意有导致脑梗死的风险。
