Division of Neurology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
Division of Neurology, Department of Medicine, Bumrungrad International Hospital, Bangkok 10110, Thailand.
Mult Scler Relat Disord. 2018 Feb;20:115-121. doi: 10.1016/j.msard.2018.01.010. Epub 2018 Mar 20.
Plasma exchange (PLEX) is routinely performed in neuromyelitis optica spectrum disorders (NMOSD) patients with an acute attack who do not respond to corticosteroids treatment.
To compare treatment outcomes in NMOSD patients with an acute attack between the two groups.
We retrospectively studied 67 attacks from 52 NMOSD patients. Outcome measurements using Expanded Disability Status Scale (EDSS), modified Rankin Scale (mRS) were compared.
There were 23 IVMP responders, 16 IVMP non-responders refusing PLEX, 12 IVMP non-responders/PLEX responders, and 16 IVMP/PLEX non-responders. The IVMP-responders showed faster improvement since the time of discharge but seemed to have less treatment benefit over time. However, IVMP non-responders/PLEX responders showed continuous and maximum improvement at 6 months (ΔEDSS from nadir: 1 for IVMP-responders vs 0.5 for IVMP non-responders without PLEX vs 2.75 IVMP non-responders/PLEX-responders vs 0.5 IVMP/PLEX non-responders; p = 0.49) and had comparable outcomes to the IVMP-responders (nadir EDSS 8.0 to 5.25 [ΔEDSS = 2.75] vs nadir EDSS 6.5 to 5.0; [ΔEDSS = 1.5], respectively).
Add - on PLEX treatment in NMOSD patients with an acute attack should be considered in those not responding to IVMP alone.
对于皮质类固醇治疗反应不佳的视神经脊髓炎谱系疾病（NMOSD）急性发作患者，常进行血浆置换（PLEX）。
比较两组 NMOSD 急性发作患者的治疗结局。
我们回顾性研究了 52 例 NMOSD 患者的 67 次发作。采用扩展残疾状态量表（EDSS）、改良 Rankin 量表（mRS）进行疗效评估。
23 例患者为 IVMP 有效，16 例 IVMP 无效且拒绝 PLEX，12 例 IVMP 无效/PLEX 有效，16 例 IVMP 和 PLEX 均无效。IVMP 有效组自出院时起改善较快，但随时间推移获益似乎较少。然而，IVMP 无效/PLEX 有效组在 6 个月时持续且最大程度改善（从最低值起 EDSS 变化：IVMP 有效组为 1，IVMP 无效且未行 PLEX 组为 0.5，IVMP 无效/PLEX 有效组为 2.75，IVMP 和 PLEX 均无效组为 0.5；p = 0.49），与 IVMP 有效组结局相当（最低 EDSS 值分别为 8.0 至 5.25[EDSS 变化值为 2.75]和 6.5 至 5.0[EDSS 变化值为 1.5]）。
对于皮质类固醇治疗反应不佳的 NMOSD 急性发作患者，应考虑加用 PLEX 治疗。
