McCombe P A, Pollard J D, McLeod J G
Department of Medicine, University of Sydney, NSW.
Clin Exp Neurol. 1988;25:53-60.
Patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) often respond to plasma exchange. One explanation for this is that circulating factors, such as antibodies or toxic factors, are removed from the serum. We studied CIDP nerves and CIDP sera for the presence of antibodies to myelin, Schwann cells and galactocerebroside, using immunofluorescence and enzyme-linked immunosorbent assays. On 1 of 28 CIDP nerve biopsies there was evidence of an IgG antibody bound to myelin. One of 57 CIDP sera had evidence of an antimyelin antibody, compared with 12 of 68 Guillain-Barré syndrome sera. We failed to find evidence of antibodies to Schwann cells or galactocerebroside in CIDP. The serum from only 1 of 11 patients showed demyelinating activity after direct intraneural injection. Thus these techniques do not demonstrate the presence of humoral factors to the tested antigens in the majority of CIDP patients. However, more sensitive methods may demonstrate antibodies to these antigens. Alternatively, CIDP may be associated with antibodies or factors toxic to other antigens, or else the response to plasma exchange may not be due to removal of a humoral factor.
慢性炎症性脱髓鞘性多发性神经根神经病（CIDP）患者通常对血浆置换有反应。对此的一种解释是，循环因子，如抗体或毒性因子，从血清中被清除。我们使用免疫荧光和酶联免疫吸附测定法，研究了CIDP神经和CIDP血清中是否存在针对髓磷脂、施万细胞和半乳糖脑苷脂的抗体。在28例CIDP神经活检中有1例存在与髓磷脂结合的IgG抗体证据。57例CIDP血清中有1例存在抗髓磷脂抗体证据，相比之下，68例吉兰-巴雷综合征血清中有12例存在该抗体。我们在CIDP中未发现针对施万细胞或半乳糖脑苷脂的抗体证据。11例患者中只有1例的血清在直接神经内注射后显示出脱髓鞘活性。因此，这些技术在大多数CIDP患者中未证明存在针对所检测抗原的体液因子。然而，更敏感的方法可能会证明存在针对这些抗原的抗体。或者，CIDP可能与针对其他抗原的抗体或毒性因子有关，否则对血浆置换的反应可能不是由于体液因子的清除。
