Hisanaga Kinya
Department of Neurology, Miyagi National Hospital.
Rinsho Shinkeigaku. 2012;52(11):1234-6. doi: 10.5692/clinicalneurol.52.1234.
Behçet disease and Sweet disease are multisystem inflammatory disorders involving mucocutaneous tissue as well as nervous system (neuro-Behçet disease and neuro-Sweet disease). Pathological findings in the encephalitis are chiefly perivascular cuffing of small venules by neutrophils, T lymphocytes, and macrphages. Destruction of the brain substrates is mild in neuro-Sweet disease compared with that of neuro-Behçet disease, especially that of chronic progressive subtype. HLA (human leukocyte antigen)-B51 is frequently positive in neuro-Behçet disease, and the frequencies of HLA-B54 and Cw1 in neuro-Sweet disease are significantly higher than not only those in Japanese normal controls but also those in patients with these diseases without nervous complications. These HLA types are considered as risk factors which are directly associated with the etiology of these diseases. Prednisolone is usually used for the treatment of acute phase of both diseases. Methotrexate and infliximab are administered to patients with the chronic progressive type of neuro-Behçet disease. Colchicine and dapsone are prescribed to prednisolone-dependent recurrent cases of neuro-Sweet disease.
白塞病和Sweet病是累及皮肤黏膜组织以及神经系统的多系统炎症性疾病(神经白塞病和神经Sweet病)。脑炎的病理表现主要为小静脉周围有中性粒细胞、T淋巴细胞和巨噬细胞形成的套袖样浸润。与神经白塞病相比,神经Sweet病中脑实质的破坏较轻,尤其是慢性进行性亚型。神经白塞病中人类白细胞抗原(HLA)-B51常呈阳性,神经Sweet病中HLA-B54和Cw1的频率不仅显著高于日本正常对照,也高于无神经并发症的这些疾病患者。这些HLA类型被认为是与这些疾病病因直接相关的危险因素。泼尼松龙通常用于治疗这两种疾病的急性期。甲氨蝶呤和英夫利昔单抗用于慢性进行性神经白塞病患者。秋水仙碱和氨苯砜用于对泼尼松龙依赖的神经Sweet病复发患者。