Adoue D, Vilain C, Fontan B, Le Tallec Y, Albarède J L, Oksman F
Département de Médecine interne, CH de Toulouse.
Presse Med. 1987 Oct 10;16(33):1625-7.
High dose intravenous immunoglobulins have proved effective immunosuppressants in various autoimmune diseases, including bullous pemphigoid. However, their specific point of impact remains undetermined and no study supports the need for high doses. We treated elderly patients with proven and corticosteroid-resistant bullous pemphigoid, using a therapeutic regimen consisting of continuous oral corticosteroid therapy and continuous infusion of immunoglobulins in very low doses by means of an electric syringe. Clinical improvement was observed in every case without any characteristic change in immunological parameters (anti-basal membrane antibody, cutaneous immune deposits), which suggests that immunoglobulins administered in that way act on immune response regulatory mechanisms. The therapeutic effect observed potentiates that of corticosteroids which can thus be given in lower doses in bullous pemphigoid.
高剂量静脉注射免疫球蛋白已被证明是治疗包括大疱性类天疱疮在内的各种自身免疫性疾病的有效免疫抑制剂。然而，它们的具体作用点仍未确定，且没有研究支持使用高剂量的必要性。我们采用一种治疗方案，即持续口服皮质类固醇治疗，并通过电动注射器以极低剂量持续输注免疫球蛋白，来治疗确诊且对皮质类固醇耐药的老年大疱性类天疱疮患者。在每例患者中均观察到临床改善，而免疫参数（抗基底膜抗体、皮肤免疫沉积物）无任何特征性变化，这表明以这种方式给予的免疫球蛋白作用于免疫反应调节机制。观察到的治疗效果增强了皮质类固醇的效果，因此在大疱性类天疱疮中可以给予较低剂量的皮质类固醇。
