病例研究

反复发作视神经脊髓炎 11 年随访一例并 NMOSD 治疗的现状与展望

A case of recurrent neuromyelitis optica with an 11-year follow-up: current status and future prospects in the treatment of NMO

:665-674
 
视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorder, NMOSD)是一种罕见的中枢神经系统自身免疫性疾病,主要表现为视神经炎和纵向广泛性横贯性脊髓炎,复发率高,反复发作可导致不可逆的神经功能损害。文章报告了一例44岁女性的NMOSD患者,以反复发作的视神经炎为特征,经过长达11年的随访,共历经4次临床发作。患者首次发作时,因治疗过程中糖皮质(激素)减量过快和自行停药导致病情恶化,后续发作中采用了规范的急性期治疗和缓解期预防复发方案,包括大剂量激素冲击、免疫抑制剂(硫唑嘌呤、吗替麦考酚酯)和静脉注射免疫球蛋白(intravenous immunoglobulin, IVIG)等,显著延长了缓解期。最近一次复发中,患者首次使用了新型生物制剂伊奈丽珠单抗(CD19单克隆抗体)预防复发治疗。文章通过具体病例分析和文献综述,反映NMOSD急性期和缓解期预防复发治疗策略的时代变迁,并探索新型生物制剂使用过程中需要注意的问题。
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease that affects the central nervous system. It is predominantly characterized by optic neuritis and longitudinally extensive transverse myelitis. Given its high relapse rate, repeated attacks of NMOSD can result in irreversible nerve damage. The article details the case of a 44-year-old female patient with NMOSD, whose primary manifestion was recurrent optic neuritis.The patient was followed up over an 11-year span, during which she experienced a total of four clinical relapses. During the initial attack, the patient's condition deteriorated because of the rapid tapering of steroid therapy and her self-initiated discontinuation of medication. In subsequent attacks, standardized treatments for the acute phase and strategies for preventing relapses were implemented. These included high-dose steroid pulses, immunosuppressants (azathioprine, mycophenolate mofetil), and intravenous immunoglobulin (IVIG). These interventions significantly prolonged the remission period. During the most recent relapse, the patient received treatment with the novel biologic agent inebilizumab, which is  a CD19 monoclonal antibody. Through a comprehensive case analysis and a review of relevant literature , this report sheds light on the evolving treatment strategies for managing the acute phase and preventing relapses during remission in NMOSD. It also highlights key considerations in the practical application of the new biologic therapies.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
    浏览
  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
    浏览