Rahman M U, Poe D S, Choi H K
Rheumatology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Curr Opin Rheumatol. 2001 May;13(3):184-9. doi: 10.1097/00002281-200105000-00006.
Autoimmune vestibulo-cochlear disorders (AVCD) represent a group of syndromes with overlapping clinical features, manifesting as sensorineural hearing loss, often associated with vertigo, tinnitus, and aural fullness, and believed to be caused by an autoimmune mechanism. Although definitive evidence of a classic "autoimmune process" is still lacking, substantial indirect evidence has accumulated to strongly indicate such a pathogenesis. Rapidly progressing AVCD is analogous to rapidly progressive glomerulonephritis in that inner ear inflammation progresses to severe, irreversible damage within 3 months of onset (and often much more quickly). Thus patients with rapidly progressive AVCD are treated with a sense of urgency. Prompt treatment with corticosteroids and other antirheumatic/immunosuppressive agents can preserve hearing and vestibular functions. We are not aware of any randomized controlled clinical trials evaluating the efficacy of antirheumatic/immunosuppressive agents in AVCD. In this article we review reports of various therapies that have been tried in this condition and our experience of etanercept therapy in AVCD.
自身免疫性前庭蜗神经疾病（AVCD）是一组具有重叠临床特征的综合征，表现为感音神经性听力损失，常伴有眩晕、耳鸣和耳闷胀感，被认为是由自身免疫机制引起的。尽管仍缺乏经典“自身免疫过程”的确切证据，但大量间接证据已积累起来，有力地表明了这种发病机制。快速进展性AVCD类似于快速进展性肾小球肾炎，即内耳炎症在发病后3个月内（通常更快）进展为严重的、不可逆的损害。因此，快速进展性AVCD患者的治疗具有紧迫性。及时使用皮质类固醇和其他抗风湿/免疫抑制剂进行治疗可保留听力和前庭功能。我们不知道有任何评估抗风湿/免疫抑制剂在AVCD中疗效的随机对照临床试验。在本文中，我们回顾了在此病中尝试过的各种治疗方法的报告以及我们使用依那西普治疗AVCD的经验。
