免疫治疗妊娠合并急性炎性脱髓鞘性多发神经根神经病

Immunotherapy of pregnancy complicating acute inflammatory demyelinating polyneuropathie

目的探讨免疫治疗妊娠合并急性炎性脱髓鞘性多发神经根神经病(acute inflammatory demyelinating polyneuropathies,AIDP)的疗效和母婴预后。方法回顾性分析南开大学附属第四中心医院2010年8月至2018年1月收治的45例妊娠合并AIDP的患者资料。依据免疫治疗方式将入组患者分为静脉注射免疫球蛋白(intravenous immunoglobulin,IVIg)组和血浆置换(plasma exchange,PE)组。对比分析两组患者免疫治疗的疗效和母婴预后。结果IVIg组25例,PE组20例。IVIg组和PE组治疗有效率分别为84.0%(21/25)和85.0%(17/20),机械通气率分别为12.0%(3/25)和15.0%(3/20),病死率分别为4.0%(1/25)和5.0%(1/20),差异均无统计学意义(P>0.05)。IVIg组和PE组的治疗显效时间分别为(5.0±1.0)d和(7.1±3.4)d(t=-2.825,P=0.010),好转时间分别为(9.5±1.3)d和(10.0±1.6)d(t=-1.111,P=0.603),基本治愈时间分别为(14.1±1.8)d和(17.1±2.8)d(t=-3.875,P=0.071),临床治愈时间分别为(22.7±4.7)d和(22.4±6.9)d(t=0.136,P=0.159)。IVIg最常见的并发症是荨麻疹4例(P=0.561)、一过性发热3例(P=0.418)和头痛3例(P=0.418)。PE组最常见的并发症是低钙血症5例(P=0.042)和电解质紊乱5例(P=0.042)。43例患者随访1年无吉兰-巴雷综合征(GBS)复发。婴儿均体健、无先天畸形的发生。结论IVIg和PE治疗妊娠合并AIDP总体安全、有效。母婴多预后良好。

Objective To explore the immunotherapy and prognosis of pregnancy complicating acute inflammatory demyelinating polyneuropathies(AIDP).Methods The clinical data of 45 hospitalized pregnancy complicating AIDP patients recruited from August 2010 to January 2018 at the the Nankai University Affiliated Tianjin Fourth Central Hospital were collected and analyzed retrospectively,and patients were divided into the intravenous immunoglobulin(IVIg)group and plasma exchange(PE)group.The immunotherapy and prognosis were compared between the two groups.Results The efficiency of IVIg group(25 cases)and PE group(23 cases)was 84.0%(21/25)and 85.0%(17/20),mechanical ventilation was 12.0%(3/25)and 15.0%(3/20),and the mortality was 4.0%(1/25)and 5.0%(1/20),respectively.The effective time of IVIg group and PE group was(5.0±1.0)d and(7.1±3.4)d(t=-2.825,P=0.010),the improvement time was(9.5±1.3)d and(10.0±1.6)d(t=-1.111,P=0.603),the basic cure time was(14.1±1.8)d and(17.1±2.8)d(t=-3.875,P=0.071),and the cure time was(22.7±4.7)d and(22.4±6.9)d(t=0.136,P=0.159),respectively.The most common complications of IVIg were urticaria(4 cases,P=0.042),transient fever(3 cases,P=0.418)and headache(3 cases,P=0.418).The most common complications in the PE group were hypocalcemia(5 cases,P=0.042)and electrolyte disturbance(5 cases,P=0.042).43 patients were followed up for 1 year without recurrence of GBS.The infants were healthy and had no congenital malformation.Conclusions IVIg and PE is generally safe and effective.The prognosis of maternal and infant is generally good.