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[一名多发性硬化症患者使用干扰素β-1a治疗继发的视网膜病变]

[Retinopathy secondary to treatment with Interferon beta-1a in a patient with multiple sclerosis].

作者信息

Mallada-Frechín J, Abellán-Miralles I, Alfaro-Beltra M L, Medrano V, Muñoz-Gil M B, Fernández-Izquierdo S, Piqueras-Rodríguez L

机构信息

Unidad de Neurología, Hospital General de Elda, 03600 Elda, Spain.

出版信息

Rev Neurol. 2005;40(8):482-4.

Abstract

INTRODUCTION

Although visual symptoms of multiple sclerosis (MS) are very frequent, they are rarely related with treatment with interferon. This is the first case reported in the literature of retinopathy associated with subcutaneous interferon beta-1a, and the second related to interferons in MS.

CASE REPORT

A 30-year-old female diagnosed with relapsing-remitting MS who, at 3 months after starting treatment with subcutaneous interferon beta-1a (44 microg/3 times a week), displayed visual disorders. Retinal lesions in the form of cotton wool spots were found as symptoms of microinfarctions in the retina. The lesions got better after stopping treatment and the patient was found to be asymptomatic.

CONCLUSIONS

The existence of retinopathy secondary to interferon has been known in the treatment of hepatitis C and neoplasias with interferon alfa since 1990. Despite being a frequently occurring complication, it is usually a mild condition and disappears on withdrawing treatment, or even if it is continued. It is attributed to deposits of immunocomplexes and complement activation in the blood vessels of the retina. Only one other case associated to treatment of MS with interferon beta has been reported in the literature, more specifically related to subcutaneous interferon beta-1b. The clinical characteristics of both cases are identical to those associated to interferon alfa. Despite the fact that the frequency of appearance seems to be lower than in the case of interferon alfa, the physician must bear in mind the possibility encountering this complication.

摘要

引言

尽管多发性硬化症(MS)的视觉症状非常常见,但它们很少与干扰素治疗相关。这是文献中报道的首例与皮下注射干扰素β-1a相关的视网膜病变病例,也是第二例与MS中干扰素相关的病例。

病例报告

一名30岁女性被诊断为复发缓解型MS,在开始皮下注射干扰素β-1a(44微克/每周3次)治疗3个月后出现视觉障碍。发现视网膜病变表现为棉絮斑,这是视网膜微梗死的症状。停止治疗后病变好转,患者无症状。

结论

自1990年以来,在使用干扰素α治疗丙型肝炎和肿瘤的过程中,已经知道存在继发于干扰素的视网膜病变。尽管这是一种常见的并发症,但通常病情较轻,在停药后甚至继续用药时也会消失。这归因于视网膜血管中免疫复合物的沉积和补体激活。文献中仅报道了另一例与干扰素β治疗MS相关的病例,更具体地说是与皮下注射干扰素β-1b相关。这两例病例的临床特征与干扰素α相关的病例相同。尽管出现频率似乎低于干扰素α的情况,但医生必须牢记可能会遇到这种并发症。

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