Tatay J, Díez-Tejedor E, Frank A, Tejada J, Marrero C, Barreiro P
Servicio de Neurología, Hospital Universitario La Paz, Madrid, España.
Rev Neurol. 1997 Sep;25(145):1402-6.
In the past decade good therapeutic results have been reported with high dosage of intravenous immunoglobulins (Ig i.v.) in various autoimmune disorders, including myasthenia gravis (MG). Plasmapheresis has been used successfully in this disorder on indications similar to those described for the use of Ig i.v.. We have used sequential treatment of plasmapheresis followed by high doses of intravenous gammaglobulin in MG, seeking complementary benefits from the two kinds of treatment.
The sample included 10 patients with MG (7 of Osserman's grade II-B, 1 of II-A and 2 of III). We began treatment with plasmapheresis, and then continued with an i.v. infusion of Ig at a dose of 400 mg/Kg/day for 5 days. To evaluate the response to treatment, we used the classification system for muscle weakness based on the Virginia University modification of Osserman's grades, on the clinical involvement grade scales and on functional activity.
All patients showed statistically significant improvement of the parameters studied. Improvement started between the first and sixth day, following administration of Ig i.v. and persisted for the following 16 weeks.
We consider that combined treatment with plasmapheresis and Ig i.v. may synergically potentiate the immunological effects since they have different mechanisms of action. The indication for this is limited to serious clinical conditions resistant to other treatment, to speed recovery.
在过去十年中，已有报道称高剂量静脉注射免疫球蛋白（Ig i.v.）在包括重症肌无力（MG）在内的各种自身免疫性疾病中取得了良好的治疗效果。血浆置换已成功用于该疾病，其适应症与静脉注射免疫球蛋白的使用适应症相似。我们在重症肌无力患者中采用了先进行血浆置换，然后给予高剂量静脉注射丙种球蛋白的序贯治疗，以期从这两种治疗中获得互补的益处。
样本包括10例重症肌无力患者（Osserman分级II - B级7例，II - A级1例，III级2例）。我们先开始进行血浆置换治疗，然后继续以400mg/Kg/天的剂量静脉输注免疫球蛋白，持续5天。为评估治疗反应，我们使用了基于弗吉尼亚大学对Osserman分级的修改、临床受累分级量表以及功能活动的肌无力分类系统。
所有患者所研究的参数均显示出统计学上的显著改善。改善在静脉注射免疫球蛋白后的第1天至第6天开始，并持续了接下来的16周。
我们认为血浆置换和静脉注射免疫球蛋白联合治疗可能会协同增强免疫效应，因为它们具有不同的作用机制。这样做的适应症仅限于对其他治疗有抵抗的严重临床情况，以加速康复。
