TNF拮抗剂相关炎性神经系统疾病

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Mult Scler. 2011 Aug 3. [Epub ahead of print]   Inflammatory neurological disease in patients treated with tumor necrosis factor alpha inhibitors.   Solomon AJ, Spain RI, Kruer MC, Bourdette D.   Source Department of Neurology, University of Vermont College of Medicine, Fletcher Allen Health Care, University Health Center, Vermont, USA.   Abstract Background: TNF alpha inhibitor (TNFAI) therapy has been associated with inflammatory neurological syndromes. Objectives: To present 10 new cases of TNFAI associated neurological disease and a review of the literature. Methods: The design and methods were based on case series collected from Oregon Health & Sciences University and the Department of Veterans Affairs Hospital in Portland, Oregon and PubMed review. Results: We describe eight demyelinating central nervous system syndromes and two peripheral nervous system syndromes associated with TNFAI therapy. Characteristics from these cases are analyzed with data from 141 additional cases from the literature. Onset was between the ages of 36 and 65 years in 84% of CNS cases, distinguishing TNFAI-associated disease from sporadic multiple sclerosis. Symptoms occurred within one year of TNFAI therapy in 71%. Etanercept therapy was reported in the majority of cases of CNS syndromes and infliximab therapy in the majority of neuromuscular syndromes. Significant disability remained in 67% of cases although 82% had been followed for less than one year. Conclusions: Our case series and literature review demonstrates an association between TNFAI therapy and inflammatory neurological disease. While a causal relationship is suggested, this remains uncertain. TNFAI-associated neurological syndromes are associated with significant disability and longer follow-up is needed to better determine natural history and evaluate appropriate treatment interventions.   PMID: 21816758

TNF拮抗剂相关炎性神经系统疾病   Solomon AJ, et al. Mult Scler. 2011 Aug 3. 提前在线.     背景: 近年来背景: 有报道称TNF拮抗剂与炎症神经综合征有相关性。 目的: 汇报我们发现的10例新发的TNF拮抗剂伴发神经系统疾病病例，并回顾既有文献。 方法: 相关病例来自俄勒冈州健康与科学大学和美国退伍军人事务部医院(俄勒冈州波特兰市)，以及PubMed文献回顾。 结果: 我们描述了8例中枢神经系统脱髓鞘综合征以及2例外围神经系统综合征，他们均发生于TNF拮抗剂治疗过程中。结合来自既有文献报道的141例，我们对这些案例的特征进行了分析。中枢神经系统(CNS)受累患者中有84%的发表年龄介于36岁至65岁，藉此可将TNF拮抗剂相关患者与散发性多发性硬化患者相区别。症状发生在TNF拮抗剂治疗一年之内的患者比例为71%。在发生CNS综合征的患者中，较多患者接受依那西普治疗。在发生神经肌肉综合征患者中，英夫利昔治疗患者居多。尽管有82%的患者随访时间近一年，但有67%患者仍有显著的功能残疾。 结论: 我们报告的案例以及文献回顾表明TNF拮抗剂与炎性神经系统疾病之间有一定的相关性。虽然只是提示有因果关系，这种关系仍然是不确定的。TNF拮抗剂伴发的神经症状与显著的功能残疾有相关性，需要更长时间的随访以便更好地判别自然病史以及评估合适的干预措施。