Lin Cindy Shin-Yi, Krishnan Arun V, Park Susanna B, Kiernan Matthew C
Faculty of Medicine, School of Medical Science, University of New South Wales, Sydney, New South Wales, Australia.
Arch Neurol. 2011 Jul;68(7):862-9. doi: 10.1001/archneurol.2011.137.
To investigate the immediate and longitudinal mechanisms of action of intravenous immunoglobulin (IVIg) on axonal function in chronic inflammatory demyelinating polyneuropathy (CIDP).
Prospective single-center study.
Hospitals and outpatient clinics.
Clinical and functional assessment, nerve conduction studies, and 526 motor excitability studies were undertaken in 27 patients, matched before and immediately after infusion and followed up longitudinally.
Axonal excitability variables were measured before and immediately after infusion and compared with matched studies and findings in healthy controls.
Immediately after infusion, patients demonstrated decreased threshold, with significant reduction in strength-duration time constant (P = .003), reduction in accommodation to depolarization (P = .04), and reduced threshold change during hyperpolarization (P = .003), accompanied by significant decreases in superexcitability (P = .03) and subexcitability (P = .02). In contrast, changes were absent in disease controls, confirming a specific IVIg action in CIDP patients. Longitudinally, changes correlated with clinical improvement (mean [SE] increase in the Medical Research Council sum score, 2.7 [0.7]; P = .005). Increased compound muscle action potential amplitude was associated with reduction in terminal latency (correlation coefficient, -0.65; P = .02). In addition, these changes translated into improvement in functional assessment with the adjusted Inflammatory Neuropathy Cause and Treatment score, which demonstrated a significant correlation with nerve excitability variables longitudinally (P = .01).
Findings from the present series establish a modulatory effect of IVIg on axonal function in CIDP patients, suggesting that IVIg stabilizes axonal membrane potential and promotes axonal recovery.
研究静脉注射免疫球蛋白（IVIg）对慢性炎症性脱髓鞘性多发性神经病（CIDP）轴突功能的即时和纵向作用机制。
前瞻性单中心研究。
医院和门诊诊所。
对27例患者进行了临床和功能评估、神经传导研究以及526项运动兴奋性研究，在输注前和输注后即刻进行匹配，并进行纵向随访。
在输注前和输注后即刻测量轴突兴奋性变量，并与健康对照的匹配研究和结果进行比较。
输注后即刻，患者表现出阈值降低，强度-时间常数显著降低（P = 0.003），去极化适应性降低（P = 0.04），超极化期间阈值变化降低（P = 0.003），同时超兴奋性（P = 0.03）和亚兴奋性（P = 0.02）显著降低。相比之下，疾病对照组未出现变化，证实了IVIg在CIDP患者中的特异性作用。纵向来看，这些变化与临床改善相关（医学研究委员会总分平均[标准误]增加，2.7[0.7]；P = 0.005）。复合肌肉动作电位幅度增加与终末潜伏期缩短相关（相关系数，-0.65；P = 0.02）。此外，这些变化转化为经调整的炎症性神经病病因和治疗评分的功能评估改善，该评分与神经兴奋性变量纵向显著相关（P = 0.01）。
本系列研究结果证实了IVIg对CIDP患者轴突功能的调节作用，表明IVIg可稳定轴突膜电位并促进轴突恢复。
