Uzenot D, Azulay J-P, Pouget J
Service de neurologie et maladies neuromusculaires, Centre de référence des maladies neuromusculaires rares, Marseille-Nice, CHU La Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
Rev Neurol (Paris). 2007 Sep;163 Spec No 1:3S68-76.
Treatment's initiation in chronic inflammatory demyelinating polyradiculopathy (CIDP) remains a difficult medical decision. Only plasma exchanges, intravenous immunoglobulins (IVIg) and corticosteroids are proven effective treatments. Immunosuppressors are actually not first-line treatments in CIDP. Particular CIDP forms are associated with different response to treatments: pure motor CIDP should be treated by IVIg, and corticosteroids should only carefully be used in Lewis-Sumner syndrome. Otherwise, IVIg are first-line treatment in diabetic patients. Patients must be informed of side's effects and expected clinical effects. Early treatment was actually not proved to prevent axonal damages in CIDP patients, and waiting seems to be the best therapeutic option in poorly symptomatic patients. Recently, clinical guidelines were proposed to help clinician in this treatment choice, but there is no consensus about the best dose, duration or administration way to CIDP treatments. Further studies should be performed to clarify these points and to determine immunosuppressor agents place in treatment strategy.
慢性炎症性脱髓鞘性多发性神经根神经病（CIDP）的治疗启动仍然是一个艰难的医学决策。仅血浆置换、静脉注射免疫球蛋白（IVIg）和皮质类固醇被证明是有效的治疗方法。免疫抑制剂实际上并非CIDP的一线治疗方法。特定的CIDP形式与对治疗的不同反应相关：纯运动性CIDP应以IVIg治疗，而皮质类固醇仅应谨慎用于Lewis-Sumner综合征。否则，IVIg是糖尿病患者的一线治疗方法。必须告知患者副作用和预期的临床效果。实际上，早期治疗并未被证明可预防CIDP患者的轴索损伤，对于症状轻微的患者，等待似乎是最佳的治疗选择。最近，有人提出了临床指南以帮助临床医生进行这种治疗选择，但对于CIDP治疗的最佳剂量、持续时间或给药方式尚无共识。应进行进一步研究以阐明这些问题，并确定免疫抑制剂在治疗策略中的地位。
