慢性炎性脱髓鞘性多发神经病的神经系统功能障碍和康复治疗现状

Neurological functional disturbance and present rehabilitative treatment of chronic inflammatory demyelinating polyneuropathy

目的:综述慢性炎性脱髓鞘性多发神经病的临床特征,诊断方法及治疗策略的研究现状。资料来源:应用计算机检索Medline2000-01/2005-09与慢性炎性脱髓鞘性多发神经病临床、诊断、治疗进展相关的文章,检索词“CIDP熏diag-nosis熏treatment”,并限定文章语言种类为“English”,同时手工及计算机检索万方数据库2000-01/2005-09相关文章,限定文章语种为中文,检索词“周围神经病”。资料选择:对资料进行初审,选取与慢性炎性脱髓鞘性多发神经病临床研究及治疗进展的相关文献,排除个案报道。资料提炼:共收集到42篇相关文章,并选取其中25篇,排除了17篇重复的文献。资料综合:25篇文章中有10篇针对慢性炎性脱髓鞘性多发神经病的临床特征,7篇文献关于诊断方法,9篇关于治疗进展。慢性炎性脱髓鞘性多发神经病可分为经典的和非典型,非典型包括获得性肢体远端对称性脱髓鞘性神经病、多灶性运动神经病和多灶性获得性脱髓鞘性感觉运动性神经病等。目前应用最广泛的治疗是静脉内免疫球蛋白,血浆交换,皮质类固醇,这3种主要疗法之间的疗效无差异,选择哪种方法主要根据费用和副作用。康复治疗强调应在疾病早期即进行。结论:慢性炎性脱髓鞘性多发神经病是一种慢性进展或慢性复发性神经病。非典型和经典的慢性炎性脱髓鞘性多发神经病有不同的治疗效果和预后,因此,充分认识疾病及早治疗具有重要意义。

OBJECTIVE： To review the researches on clinical features of nervous system, diagnostic procedures and trsatment strategies on chronic inflammatory demyelinating polyneuropathy （CIDP）. DATA SOURCES： Using the key terms ＂CIDP, diagnosis, treatment＇, the Medline database was searched with computer to identify articles on the clinical features, diagnosis and treatment of CIDP published from January 2000 to September 2005 in English. Manual and computer-search of Wanfang database was also performed to find relevant articles published from January 2000 to September 2005 with the key words of ＂peripheral neuropathy＂ in Chinese at the same time. STUDY SELECTION： After the first selection, the relevant literatures on the clinical study and treat progress of CIDP were included, and the case reports were excluded. DATA EXTRACTION： Of the 42 articles were selected, 25 articles were enrolled and 17 were excluded because of their repetitive contents. DATA SYNTHESIS： Of 25 eligible articles, 10 focused on the investigation of clinical features of CIDP, 7 on the diagnosis approach of CIDP, and 9 on treatment progress of CIDP. The CIDP could be divided into typical and non-typical that included distal symmetrical demyelinating neuropathy, multifocal motor neuropathy （MMN） and muhifocal demyelinating motor neuropathy, etc. At present, the most three common used therapies were immunoglobulin in vein, exchange of plasma and corticosteroid, and there was insignificant difference among these therapies. To use which kind of method was mainly dependent on the fee and side effect. The rehabilitative treatment should stress the early performance of disease. CONCLUSION： CIDP is characterized by the course of a chronic progressive or chronic relapsing neuropathy. It is different that treatment effect and prognosis between the atypical varieties of CIDP and the typical CIDP. So, it is important to fully recognize disease and early treatment.