Wegner Brian, Ahmed Iftekhar
Trinity Lutheran Hospital, Kansas City, MO 64108, USA.
Clin Neurol Neurosurg. 2002 Dec;105(1):3-8. doi: 10.1016/s0303-8467(02)00017-3.
To investigate effectiveness of long-term treatment of myasthenia gravis (MG) with intravenous immunoglobulin (IVIG).
There are no definitive studies showing effectiveness of IVIG therapy in long-term treatment of MG. Most studies have investigated the acute treatment of MG with IVIG. We describe our experience with long-term treatment of MG with IVIG in six patients.
Acute treatment of MG by IVIG therapy has been well established in the literature. We describe six patients who were treated on a long-term basis with IVIG therapy. All of these patients had positive acetylcholine receptor antibody titers. They all received initial infusion for 5 days of IVIG at a dose of 400 mg/kg/day followed by maintenance therapy of 400 mg/kg for 1 day every 3-4 months. These patients were followed for 2 years. All other medications, including prednisone and cholingeric drugs such as Mestinon, were gradually weaned. For the last years, each of these patients maintained better than functional class 2 on an average of 1.5-2.2+/-0.5 grades on the University of Virginia modification of Ossermann's classification scale for MG. They were solely treated with IVIG infusion every 3-4 months without any other concomitant medications. Three of the patients had previously undergone thymectomies. None of the patients noticed any worsening in their scores on the University of Virginia modification of Ossermann's classification worse than Grade II in the last 2 years. There were no complications related to IVIG therapy, and all patients tolerated a single infusion of IVIG every 3-4 months at 400 mg/kg for 1 day.
Our study demonstrates that IVIG maintenance is effective treatment of MG in selected patients and it is well tolerated.
IVIG therapy is a convenient, effective therapy when used selectively for treatment of MG on a long-term basis without any significant side effects.
探讨静脉注射免疫球蛋白（IVIG）长期治疗重症肌无力（MG）的有效性。
尚无明确研究表明IVIG疗法在MG长期治疗中的有效性。大多数研究探讨的是IVIG对MG的急性治疗。我们描述了6例MG患者接受IVIG长期治疗的经验。
IVIG治疗MG的急性治疗在文献中已有充分记载。我们描述了6例接受IVIG长期治疗的患者。所有这些患者的乙酰胆碱受体抗体滴度均为阳性。他们均先接受为期5天的IVIG初始输注，剂量为400mg/kg/天，随后每3 - 4个月接受一次400mg/kg的维持治疗，为期1天。对这些患者进行了2年的随访。所有其他药物，包括泼尼松和胆碱能药物如美斯的明，均逐渐减量。在过去几年中，这些患者在弗吉尼亚大学对奥斯勒曼MG分类量表的修订版上，平均维持在功能分级2级以上，评分为1.5 - 2.2±0.5级。他们仅每3 - 4个月接受一次IVIG输注，无需任何其他伴随药物。其中3例患者此前接受过胸腺切除术。在过去2年中，所有患者在弗吉尼亚大学对奥斯勒曼分类量表的修订版上的评分均未出现比II级更差的恶化情况。未发生与IVIG治疗相关的并发症，所有患者均能耐受每3 - 4个月一次、剂量为400mg/kg、为期1天的单次IVIG输注。
我们的研究表明，IVIG维持治疗对部分MG患者有效且耐受性良好。
IVIG疗法在选择性用于MG的长期治疗时是一种方便、有效的疗法，且无明显副作用。
