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静脉注射免疫球蛋白G在慢性免疫性脱髓鞘/神经元性多发性神经病、2型糖尿病性神经病以及可能在严重急性呼吸综合征中具有显著益处。

Intravenous immunoglobulin G is remarkably beneficial in chronic immune dysschwannian/dysneuronal polyneuropathy, diabetes-2 neuropathy, and potentially in severe acute respiratory syndrome.

作者信息

Engel W K

机构信息

USC Neuromuscular Center, Keck School of Medicine, Good Samaritan, Hospital, Los Angeles, CA, USA.

出版信息

Acta Myol. 2003 Dec;22(3):97-103.

Abstract

Chronic Immune Dysschwannian/Dysneuronal Polyneuropathy is an autoimmune peripheral-nerve and/or nerve-root disorder known to usually respond to intravenous immunoglobulin-G treatment. Benefit can involve any combination of motor-nerve fibers and large and small sensory-nerve fibers responsible for a progressively crippling, unbalancing, discomforting or painful disorder. "Diabetic neuropathy" is commonly considered untreatable. However, 81% of my 48 recently-summarized type-2 diabetes patients with polyneuropathy, adequately-treated with intravenous immunoglobulin-G, off-label, were relieved, sometimes completely, of various motor and sensory symptoms, including pain, thereby resembling Chronic Immune Dysschwannian/Dysneuronal Polyneuropathy. Spinal fluid protein in them is often elevated, higher values seeming to auger a better intravenous immunoglobulin-G response. Continuing the improvement requires continuing the intravenous immunoglobulin-G treatment, indicating both intravenous immunoglobulin-G responsiveness and dependency. The intravenous immunoglobulin-G responsive type-2 diabetes polyneuropathy usually is dysschwannian, sometimes mainly dysneuronal intravenous immunoglobulin-G, the most beneficial and safest treatment, is costly, but if intravenous immunoglobulin-G-treatability of a dysimmune component of type-2 diabetes neuropathy is overlooked, dismissed or rejected, as commonly happens, other costs are high regarding the patient's worsening morbidity and disability, and resultant need for increased medical care. A novel intravenous immunoglobulin-G regimen effective for fragile patients is Two Non-Consecutive-Days Every Week, using 0.4 gm/kg body wt/day. Possible molecular mechanisms of intravenous immunoglobulin-G benefit are discussed. I propose that a) there is a higher incidence of Chronic Immune Dysschwannian/Dysneuronal Polyneuropathy-like neuropathy in type-2 diabetes patients and in patients with a strong family history of type-2 diabetes, and b) the intravenous immunoglobulin-G-treatable neuropathy in type-2 diabetes can be brought on by the genetico-diabetoid-2 state. The genetic-metabolic milieu (but not necessarily glucose dysmetabolism per se.) of type-2 diabetes putatively predisposes to the presumably-dysimmune intravenous immunoglobulin-G-responsive polyneuropathy. In some of our patients, especially ones having a strong type-2 diabetes genetic background, the intravenous immunoglobulin-G-responsive neuropathy preceded the diagnosis of type-2 diabetes by 5-10 years. Accordingly, Chronic Immune Dysschwannian/Dysneuronal Polyneuropathy patients having a strong type-2 diabetes genetic background are designated "genetico-diabetoid-2 neuropathy" prior to their manifesting type-2 diabetes. Intravenous immunoglobulin-G is herein suggested as a treatment for Severe Acute Respiratory Syndrome, a recent, and feared-repetitive, pandemic with many fatalities caused by a highly-contagious mutant coronavirus, for which there is no definitive treatment. Intravenous immunoglobulin-G might: a) combat a dysimmune component of Severe Acute Respiratory Syndrome, including the reactive cytokine-chemokine storm against respiratory tissues; b) contain some antibodies effective against the coronavirus non-specific components of Severe Acute Respiratory Syndrome; c) block host-cell receptors for the virus; and d) counteract secondary infections.

摘要

慢性免疫性脱髓鞘/神经元性多神经病是一种自身免疫性周围神经和/或神经根疾病,已知通常对静脉注射免疫球蛋白G治疗有反应。益处可能涉及运动神经纤维以及负责导致逐渐致残、失衡、不适或疼痛疾病的大小感觉神经纤维的任何组合。“糖尿病性神经病变”通常被认为无法治疗。然而,在我最近总结的48例2型糖尿病合并多神经病患者中,81%接受了静脉注射免疫球蛋白G的超说明书用药治疗,各种运动和感觉症状,包括疼痛,有时完全缓解,从而类似于慢性免疫性脱髓鞘/神经元性多神经病。他们的脑脊液蛋白常常升高,较高的值似乎预示着对静脉注射免疫球蛋白G有更好的反应。持续改善需要持续静脉注射免疫球蛋白G治疗,这表明对静脉注射免疫球蛋白G有反应性和依赖性。静脉注射免疫球蛋白G反应性2型糖尿病多神经病通常是脱髓鞘性的,有时主要是神经元性的。静脉注射免疫球蛋白G是最有益和最安全的治疗方法,但成本高昂。但是,如果像通常那样忽视、摒弃或拒绝2型糖尿病神经病变的免疫异常成分对静脉注射免疫球蛋白G的可治疗性,那么患者病情恶化、致残以及由此导致的医疗护理需求增加的其他成本就会很高。一种对体弱患者有效的新型静脉注射免疫球蛋白G方案是每周两次非连续日给药,剂量为0.4克/千克体重/天。文中讨论了静脉注射免疫球蛋白G产生益处的可能分子机制。我提出:a)2型糖尿病患者以及有2型糖尿病家族病史的患者中,慢性免疫性脱髓鞘/神经元性多神经病样神经病变的发病率更高;b)2型糖尿病中可通过静脉注射免疫球蛋白G治疗的神经病变可能由遗传 - 糖尿病样2状态引起。2型糖尿病的遗传 - 代谢环境(但不一定是葡萄糖代谢异常本身)推测易导致可能免疫异常的静脉注射免疫球蛋白G反应性多神经病。在我们的一些患者中,尤其是那些有强烈2型糖尿病遗传背景的患者,静脉注射免疫球蛋白G反应性神经病变在2型糖尿病诊断前5至10年就已出现。因此,具有强烈2型糖尿病遗传背景的慢性免疫性脱髓鞘/神经元性多神经病患者在出现2型糖尿病之前被称为“遗传 - 糖尿病样2神经病变”。本文建议将静脉注射免疫球蛋白G作为严重急性呼吸综合征的一种治疗方法,严重急性呼吸综合征是一种近期令人恐惧且可能反复出现的大流行病,由一种高传染性的突变冠状病毒导致众多死亡,目前尚无确切治疗方法。静脉注射免疫球蛋白G可能:a)对抗严重急性呼吸综合征的免疫异常成分,包括针对呼吸组织的反应性细胞因子 - 趋化因子风暴;b)含有一些对严重急性呼吸综合征冠状病毒非特异性成分有效的抗体;c)阻断病毒的宿主细胞受体;d)对抗继发感染。

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