Gajdos Philippe, Chevret Sylvie
Medical Intensive Care Department, Raymond Poincaré Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Versailles Saint-Quentin University, Garches, France.
Ann N Y Acad Sci. 2008;1132:271-5. doi: 10.1196/annals.1405.001. Epub 2007 Dec 20.
The results of four randomized controlled trials were examined to assess the efficacy of intravenous immunoglobulin (IVIG) for myasthenia gravis (MG) acute exacerbations. The first trial compared plasma exchange (PE) and IVIG in 87 patients. At day 15, the mean change in the Myasthenic Muscular Score (MMS) was 16.6 (95% CI 11.6-21.6) in the PE group and 15.6 (95% CI 10.9-20.3) in the IVIG group (Wilcoxon signed rank test, P = 0.65). The second trial compared IVIG to oral methylprednisolone, and 33 patients were included. The mean (SD) sum of the two most pathological items of the Quantitative Myasthenia Gravis Score (QMGS) at day 0 was 3.9 (1.1) for the IVIG group and 4.2 (0.7) for the methylprednisolone group. At day 14, these values were 2.9 (1.4) for the IVIG group and 2.8 (1.1) for the methylprednisolone group. The third trial compared IVIG 2 g/kg versus placebo for MG worsening. The mean change in QMGS at day 14 was -2.54 in the IVIG group and -0.89 in the placebo group (P = 0.047). A significant IVIG treatment effect was observed only in patients with more severe disease; the mean difference was -0.10 for mild MG (P = 0.914) and -3.39 for moderate to severe MG (P = 0.010). The last trial compared IGIV 2 g/kg versus 1 g/kg for MG acute exacerbation in 173 patients. The mean MMS change in both groups was similar (difference = 3.84; 95% CI -1.03 to 8.71; P = 0.12). In conclusion, IVIG may be used as treatment for MG acute exacerbations. IVIG at a dose of 1 g/kg may be sufficient.
对四项随机对照试验的结果进行了审查，以评估静脉注射免疫球蛋白（IVIG）治疗重症肌无力（MG）急性加重期的疗效。第一项试验比较了87例患者的血浆置换（PE）和IVIG。在第15天，PE组的重症肌无力肌肉评分（MMS）平均变化为16.6（95%CI 11.6 - 21.6），IVIG组为15.6（95%CI 10.9 - 20.3）（Wilcoxon符号秩检验，P = 0.65）。第二项试验将IVIG与口服甲基强的松龙进行比较，纳入了33例患者。IVIG组在第0天重症肌无力定量评分（QMGS）两项最具病理意义项目的平均（标准差）总和为3.9（1.1），甲基强的松龙组为4.2（0.7）。在第14天，IVIG组这些值为2.9（1.4），甲基强的松龙组为2.8（1.1）。第三项试验比较了IVIG 2 g/kg与安慰剂对MG病情恶化的影响。IVIG组在第14天QMGS的平均变化为 -2.54，安慰剂组为 -0.89（P = 0.047）。仅在病情较重的患者中观察到显著的IVIG治疗效果；轻度MG的平均差异为 -0.10（P = 0.914），中度至重度MG为 -3.39（P = 0.010）。最后一项试验比较了173例MG急性加重期患者中IGIV 2 g/kg与1 g/kg的效果。两组的MMS平均变化相似（差异 = 3.84；95%CI -1.03至8.71；P = 0.12）。总之，IVIG可用于治疗MG急性加重期。1 g/kg的IVIG剂量可能就足够了。
