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慢性炎症性脱髓鞘性多发性神经病与妊娠:系统综述。

Chronic inflammatory demyelinating polyneuropathy and pregnancy: systematic review.

机构信息

Neurology, Medical Faculty of the University of Cologne, Koln, Nordrhein-Westfalen, Germany.

Neurology, Chiba University Graduate School of Medicine, Chiba, Japan.

出版信息

J Neurol Neurosurg Psychiatry. 2021 May;92(5):473-478. doi: 10.1136/jnnp-2020-325321. Epub 2021 Feb 9.

Abstract

Pregnancy largely affects disease activity and clinical course in women with immune-mediated neurological disorders. Chronic inflammatory demyelinating polyneuropathy (CIDP) is rare but the most common chronic immune-mediated neuropathy; however, the effects of pregnancy on CIDP have never been investigated except case reports or series. We here provide a systematic review of the literature from 1 January 1969 to 30 June 2020 that revealed 24 women with CIDP, who had onset or relapse during pregnancy. Of these, 17 (71%) developed CIDP during the first pregnancy, and 8 (47%) had a relapse during subsequent pregnancies. Of the 17 patients, in whom the CIDP subtypes were determined, all of them had typical CIDP. First-line treatments for CIDP, such as corticosteroids, immunoglobulin and plasma exchange were efficacious and safe. We suggest that pregnancy can trigger typical CIDP in some women, and women with CIDP have a higher risk of relapse during pregnancy. The onset or relapse of CIDP during pregnancy is a rare but challenging constellation for physicians.

摘要

妊娠在很大程度上影响患有免疫介导性神经疾病的女性的疾病活动和临床过程。慢性炎症性脱髓鞘性多发性神经病(CIDP)较为罕见,但却是最常见的慢性免疫介导性神经病;然而,除了病例报告或系列病例外,从未有研究调查过妊娠对 CIDP 的影响。我们在此对 1969 年 1 月 1 日至 2020 年 6 月 30 日的文献进行了系统回顾,共发现 24 例 CIDP 患者在妊娠期间出现疾病发作或复发。其中,17 例(71%)在首次妊娠期间发生 CIDP,8 例(47%)在随后的妊娠中复发。在确定 CIDP 亚型的 17 例患者中,所有患者均为典型 CIDP。CIDP 的一线治疗,如皮质类固醇、免疫球蛋白和血浆置换,是有效且安全的。我们认为,妊娠可能会引发某些女性出现典型 CIDP,并且 CIDP 女性在妊娠期间复发的风险更高。妊娠期间 CIDP 的发作或复发对医生来说是一种罕见但具有挑战性的情况。

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