大剂量免疫球蛋白治疗重症吉兰—巴雷综合征临床研究
摘要
吉兰－巴雷综合征（GBS）是以周围神经和神经根的脱髓鞘及小血管
周围淋巴细胞和巨噬细胞的炎性反应为病理特点的自身免疫病，其病因还
不完全清楚，大部分患者病前有感染史或疫苗接种史。分子模拟机制认为，
GBS 的发病是由于病原体某些组分与周围神经组分相似，机体免疫系统
发生错误的识别，产生自身免疫性 T 细胞和自身抗体，并针对周围神经组
分发生免疫应答，引起周围神经髓鞘脱失。目前，其治疗主要包括支持对
症和病因治疗，病因治疗的目的是调节机体免疫系统，消除致病性因子对
神经的损害，并促进神经再生。最早的病因治疗应用的是糖皮质激素，近
年来，血浆交换、亲和吸附、静脉注射免疫球蛋白等疗法在临床应用日趋
广泛，并取得了较好的疗效。其中，静脉注射免疫球蛋白（IVIG）由于其
操作简便，疗效肯定，是目前应用最有前景的药物。尽管有人报道糖皮质
激素治疗 GBS 无效，但动物试验表明激素对 EAN 疗效确切。因此，目前
临床仍未完全放弃应用激素治疗 GBS。本研究观察了免疫球蛋白联合激
素治疗重症 GBS 的疗效，并与单用激素治疗进行比较，通过观察临床见
效时间、临床作用效果特别是对呼吸麻痹的影响等方面综合评价其疗效，
同时测定了部分患者治疗前后肌电图变化，计算运动神经传导速度的改
变。
对 1998 年 1 月至 2004 年 1 月收治的 67 例临床确诊的 GBS 患者进行
回顾性分析：对照组 35 例（其中男 14 例，女 21 例，年龄 12～62 岁，平
均 27.6±6.8 岁；8 例累及呼吸肌，6 例气管切开）。确诊后即在支持治疗
基础上应用地塞米松 10mg 每日一次静滴，7 天后减量；同时对不伴呼吸
麻痹患者予地塞米松 5mg 鞘内注射，隔 3 天一次，共三次。治疗组 32 例
（其中男 12 例，女 20 例，年龄 12～68 岁，平均 28.3±7.2 岁；9 例累及
37
呼吸肌，3 例气管切开）。确诊后即在对照组治疗基础上加用免疫球蛋白
（哈尔滨生化制品研究所生产，2.5g/支）0.4g/kg 体重每日一次静滴，静
滴速度 3～4ml/min，连用 5 天。治疗前及治疗 7、14、21 天分别依照 Hughes
量表进行功能评价临床分级，比较两种治疗方法的临床分级评分改善情况
及临床见效时间。治疗后 21 天，对其临床疗效按以下标准进行评定：痊
愈：脱离呼吸机，肌力恢复至 4＋级以上，生活能自理；有效：达不到痊
愈标准，但病情明显好转；无效;经治疗病情无任何好转或更重。对部分
患者在入院 1 周后及治疗 4 周后进行肌电图检查。治疗前后临床分级比较
和临床见效时间等及临床痊愈率、有效率等数据应用 PC.SPSS 软件进行
统计学分析。
两组病例年龄、性别、发病后距治疗时间、病情按 Hughes 量表分
级均未发现统计学差异（P>0.05）。两组病人均已除外严重感染、结核、
糖尿病等慢性病及严重脏器功能不全情况。两组治疗前后临床分级评分比
较：对照组和治疗组病人病情在治疗前按 Hughes 功能量表进行评价两组
无显著差异（P>0.05），而在 7、14、21 天时比较则有显著差异（14 天时
P<0.01，7、21 天时 P<0.02）。两组临床见效时间评定：观察两组病人按
Hughes 功能量表进行评价功能改善 1 级和 2 级的时间，并进行比较，治
疗组病人 Hughes 评分改善 1 级和 2 级的时间明显短于对照组。两组比较，
有显著性差异（P<0.01）。两组临床疗效评定：对照组有 6 例患者，治疗
组有 3 例患者在治疗 2 周后临床症状改善不明显而自动出院，在本研究中
作无效处理。治疗组痊愈率为 62.50%，对照组痊愈率为 37.14%，两者有
显著差异。治疗组总有效率为 90.63%，对照组总有效率为 82.85%，虽然
治疗组略高于对照组，但无统计学意义。治疗组呼吸困难平均持续时间及
气切后恢复自主呼吸时间短于对照组，气管切开少于对照组。在入院 1 周
后进行肌电图检查发现 MCV 减慢的病人 4 周后复查可见免疫球蛋白治疗
38
后 MCV 恢复快于激素治疗。由于观察例数较少，对 IVIG 治疗伴呼吸困
难病人的疗效及 MCV 的变化情况未进行统计学分析。两组均未见严重不
良反应。
IVIG 治疗 GBS 的机制尚不完全清楚，可能与以下因素有关：（1）影
响抗体。IVIG 含有具有不同特异性的特异性抗体和抗特异性抗体，有结
合并中和致病性自身抗体的潜能，因而能阻断自身抗体与自身抗原的相互
反应。IVIG 的抗特异性抗体还可能通过对 B 细胞施加负性信号影响抗体
产物。IVIG 还能够加速内源性致病性 IgG 的分解代谢，降低致病性自身
抗体的水平。（2）抑制超抗原，阻止超抗原触发的细胞毒性 T 细胞的活化
和克隆扩增，干扰 T 细胞的抗原识别。（3）阻止补体结合并防止膜溶解性
攻击性复合体（MAC）形成。（4）通过饱和、转化或下调 Fc 受体的亲和
力而诱导巨噬细胞的 Fc 受体阻断，使致敏巨噬细胞失去功能。（5）影响
细胞因子如 IL－1、IL－8、IL－6 和 TNF－α，影响 Th1和 Th2型 T 细胞，
并能影响单核细胞释放细胞因子，因此而发挥抗炎作用。（6）通过间接作
用使髓鞘修复。IVIG 还具有局部作用，对 CSF 有渗透性。因为血－神经
屏障在神
Guillain-Barre Syndrome(GBS), i.e, acute inflammatory demyelinating
polyneuropathies, is an autoimmune disease characterized by demyelinating in
peripheral nerves and nerve roots and inflammatory reaction on lymphocyte
and megaphocyte. It,s etiology remains not very clear, most of the patients
have a infection history of upper respiratory tract or diarrhea. Some has a
history of vaccinating. According to the molecular mimicry mechanism,
because some components of the pathogen are similar to that of peripheral
nerves, the human,s immunity system cannot discern it correctly, then excretes
auto-immunity T cell and auto-antibodies and responses to the components of
the PNS, causing the demyelinating on peripheral nerves. Nowadays, the
mainstay treatment is the causal treatment which based on supporting
treatment, that is, to regulate body,s immunity system, eliminate pathogenic
factors and promote regenerating of the nerve and remyelinating of the sheath.
The glucocorticosteroid is the earliest medicine applied to GBS. Recently,
plasma exchange, immunoadsorption and intravenous immunoglobulin are
gradually applied and have manifested a better effect. IVIG, because it is easy
to use and has a confirmed effect, is the most popular medicine for GBS now.
Although someone has reported that glucocorticosteroid was useless to GBS,
the animal experiments show that glucocorticosteroid is effective to EAN. So
glucocorticosteroid is still applied to GBS extensively. Our research observed
40
the effect of combining glucocorticosteroid and intravenous immunoglobulin
on treating severe GBS and compared it to that which only glucocorticosteroid
was applied then gave it a comprehensive evaluation.
From Jan. of 1998 to Jan. of 2004, 67 severe patients who received
treatment in our department were admitted in this study. All patients were
clinically diagnosed GBS. Glucocorticosteroid was given to 35 cases. After
diagnosed, the 35 patients received intravenous DXM 10mg/d for 7 days on
the base of supportive treatment, then reduced the dosage gradually. At the
same time, intrathecally DXM 5mg applied to those who had no dyspnea
every 3 days, totally 3 times. 32 cases received IVIG(0.4mg/kg/d, totally 5
days, produced by Harbin biochemistry institute) additionally. Evaluated the
grade before treatment and on the seventh and fourteenth day after treatment
respectively according to Hughes scale, compared the effective time and the
decrease of the Hughes grade of the 2 groups by t test, then compared the valid
rate of the two groups by X2 test by PC.SPSS software. Change of MCV was
also recorded and meliorating of dyspnea was observed particularly.
The two groups had no significant difference in age, sex, course and
Hughes scale（P>0.05）before treatment。Patients with severe infection,
tuberculosis, diabetes and other severe viscera dysfunction were excluded.
Evaluated the curative effect by assessing the improving grade of Hughes
scale: There was no statistic difference by Hughes scale before
treatment(P>0.05) between two groups，but on the 7th day, 14th day and 21th
day after treatment, there were significant difference (P<0.01,P<0.02
respectively). Compared the course of improving 1 and 2 grades according to
Hughes scale of two groups, we found that the course of the combined group
41
was significantly shorter than that of the DXM group (P<0.01). The valid rate
of the combined group were slightly higher than that of the DXM group
( 90.63% and 82.85% respectively)when evaluated on the 21th day (P>0.05).
IVIG could alleviate dyspnea swiftly and could promote the recovery of MCV.
The risk of onset of side effects was 8.57% for DXM group, 9.37% for
combined group. No severe side effects appeared during treatment.
Conclusions: IVIG combined with GS on treating GBS excelled that
which using GS only on clinical effective time, on improving Hughes scale
and effective rate. IVIG combined
周围淋巴细胞和巨噬细胞的炎性反应为病理特点的自身免疫病，其病因还
不完全清楚，大部分患者病前有感染史或疫苗接种史。分子模拟机制认为，
GBS 的发病是由于病原体某些组分与周围神经组分相似，机体免疫系统
发生错误的识别，产生自身免疫性 T 细胞和自身抗体，并针对周围神经组
分发生免疫应答，引起周围神经髓鞘脱失。目前，其治疗主要包括支持对
症和病因治疗，病因治疗的目的是调节机体免疫系统，消除致病性因子对
神经的损害，并促进神经再生。最早的病因治疗应用的是糖皮质激素，近
年来，血浆交换、亲和吸附、静脉注射免疫球蛋白等疗法在临床应用日趋
广泛，并取得了较好的疗效。其中，静脉注射免疫球蛋白（IVIG）由于其
操作简便，疗效肯定，是目前应用最有前景的药物。尽管有人报道糖皮质
激素治疗 GBS 无效，但动物试验表明激素对 EAN 疗效确切。因此，目前
临床仍未完全放弃应用激素治疗 GBS。本研究观察了免疫球蛋白联合激
素治疗重症 GBS 的疗效，并与单用激素治疗进行比较，通过观察临床见
效时间、临床作用效果特别是对呼吸麻痹的影响等方面综合评价其疗效，
同时测定了部分患者治疗前后肌电图变化，计算运动神经传导速度的改
变。
对 1998 年 1 月至 2004 年 1 月收治的 67 例临床确诊的 GBS 患者进行
回顾性分析：对照组 35 例（其中男 14 例，女 21 例，年龄 12～62 岁，平
均 27.6±6.8 岁；8 例累及呼吸肌，6 例气管切开）。确诊后即在支持治疗
基础上应用地塞米松 10mg 每日一次静滴，7 天后减量；同时对不伴呼吸
麻痹患者予地塞米松 5mg 鞘内注射，隔 3 天一次，共三次。治疗组 32 例
（其中男 12 例，女 20 例，年龄 12～68 岁，平均 28.3±7.2 岁；9 例累及
37
呼吸肌，3 例气管切开）。确诊后即在对照组治疗基础上加用免疫球蛋白
（哈尔滨生化制品研究所生产，2.5g/支）0.4g/kg 体重每日一次静滴，静
滴速度 3～4ml/min，连用 5 天。治疗前及治疗 7、14、21 天分别依照 Hughes
量表进行功能评价临床分级，比较两种治疗方法的临床分级评分改善情况
及临床见效时间。治疗后 21 天，对其临床疗效按以下标准进行评定：痊
愈：脱离呼吸机，肌力恢复至 4＋级以上，生活能自理；有效：达不到痊
愈标准，但病情明显好转；无效;经治疗病情无任何好转或更重。对部分
患者在入院 1 周后及治疗 4 周后进行肌电图检查。治疗前后临床分级比较
和临床见效时间等及临床痊愈率、有效率等数据应用 PC.SPSS 软件进行
统计学分析。
两组病例年龄、性别、发病后距治疗时间、病情按 Hughes 量表分
级均未发现统计学差异（P>0.05）。两组病人均已除外严重感染、结核、
糖尿病等慢性病及严重脏器功能不全情况。两组治疗前后临床分级评分比
较：对照组和治疗组病人病情在治疗前按 Hughes 功能量表进行评价两组
无显著差异（P>0.05），而在 7、14、21 天时比较则有显著差异（14 天时
P<0.01，7、21 天时 P<0.02）。两组临床见效时间评定：观察两组病人按
Hughes 功能量表进行评价功能改善 1 级和 2 级的时间，并进行比较，治
疗组病人 Hughes 评分改善 1 级和 2 级的时间明显短于对照组。两组比较，
有显著性差异（P<0.01）。两组临床疗效评定：对照组有 6 例患者，治疗
组有 3 例患者在治疗 2 周后临床症状改善不明显而自动出院，在本研究中
作无效处理。治疗组痊愈率为 62.50%，对照组痊愈率为 37.14%，两者有
显著差异。治疗组总有效率为 90.63%，对照组总有效率为 82.85%，虽然
治疗组略高于对照组，但无统计学意义。治疗组呼吸困难平均持续时间及
气切后恢复自主呼吸时间短于对照组，气管切开少于对照组。在入院 1 周
后进行肌电图检查发现 MCV 减慢的病人 4 周后复查可见免疫球蛋白治疗
38
后 MCV 恢复快于激素治疗。由于观察例数较少，对 IVIG 治疗伴呼吸困
难病人的疗效及 MCV 的变化情况未进行统计学分析。两组均未见严重不
良反应。
IVIG 治疗 GBS 的机制尚不完全清楚，可能与以下因素有关：（1）影
响抗体。IVIG 含有具有不同特异性的特异性抗体和抗特异性抗体，有结
合并中和致病性自身抗体的潜能，因而能阻断自身抗体与自身抗原的相互
反应。IVIG 的抗特异性抗体还可能通过对 B 细胞施加负性信号影响抗体
产物。IVIG 还能够加速内源性致病性 IgG 的分解代谢，降低致病性自身
抗体的水平。（2）抑制超抗原，阻止超抗原触发的细胞毒性 T 细胞的活化
和克隆扩增，干扰 T 细胞的抗原识别。（3）阻止补体结合并防止膜溶解性
攻击性复合体（MAC）形成。（4）通过饱和、转化或下调 Fc 受体的亲和
力而诱导巨噬细胞的 Fc 受体阻断，使致敏巨噬细胞失去功能。（5）影响
细胞因子如 IL－1、IL－8、IL－6 和 TNF－α，影响 Th1和 Th2型 T 细胞，
并能影响单核细胞释放细胞因子，因此而发挥抗炎作用。（6）通过间接作
用使髓鞘修复。IVIG 还具有局部作用，对 CSF 有渗透性。因为血－神经
屏障在神
Guillain-Barre Syndrome(GBS), i.e, acute inflammatory demyelinating
polyneuropathies, is an autoimmune disease characterized by demyelinating in
peripheral nerves and nerve roots and inflammatory reaction on lymphocyte
and megaphocyte. It,s etiology remains not very clear, most of the patients
have a infection history of upper respiratory tract or diarrhea. Some has a
history of vaccinating. According to the molecular mimicry mechanism,
because some components of the pathogen are similar to that of peripheral
nerves, the human,s immunity system cannot discern it correctly, then excretes
auto-immunity T cell and auto-antibodies and responses to the components of
the PNS, causing the demyelinating on peripheral nerves. Nowadays, the
mainstay treatment is the causal treatment which based on supporting
treatment, that is, to regulate body,s immunity system, eliminate pathogenic
factors and promote regenerating of the nerve and remyelinating of the sheath.
The glucocorticosteroid is the earliest medicine applied to GBS. Recently,
plasma exchange, immunoadsorption and intravenous immunoglobulin are
gradually applied and have manifested a better effect. IVIG, because it is easy
to use and has a confirmed effect, is the most popular medicine for GBS now.
Although someone has reported that glucocorticosteroid was useless to GBS,
the animal experiments show that glucocorticosteroid is effective to EAN. So
glucocorticosteroid is still applied to GBS extensively. Our research observed
40
the effect of combining glucocorticosteroid and intravenous immunoglobulin
on treating severe GBS and compared it to that which only glucocorticosteroid
was applied then gave it a comprehensive evaluation.
From Jan. of 1998 to Jan. of 2004, 67 severe patients who received
treatment in our department were admitted in this study. All patients were
clinically diagnosed GBS. Glucocorticosteroid was given to 35 cases. After
diagnosed, the 35 patients received intravenous DXM 10mg/d for 7 days on
the base of supportive treatment, then reduced the dosage gradually. At the
same time, intrathecally DXM 5mg applied to those who had no dyspnea
every 3 days, totally 3 times. 32 cases received IVIG(0.4mg/kg/d, totally 5
days, produced by Harbin biochemistry institute) additionally. Evaluated the
grade before treatment and on the seventh and fourteenth day after treatment
respectively according to Hughes scale, compared the effective time and the
decrease of the Hughes grade of the 2 groups by t test, then compared the valid
rate of the two groups by X2 test by PC.SPSS software. Change of MCV was
also recorded and meliorating of dyspnea was observed particularly.
The two groups had no significant difference in age, sex, course and
Hughes scale（P>0.05）before treatment。Patients with severe infection,
tuberculosis, diabetes and other severe viscera dysfunction were excluded.
Evaluated the curative effect by assessing the improving grade of Hughes
scale: There was no statistic difference by Hughes scale before
treatment(P>0.05) between two groups，but on the 7th day, 14th day and 21th
day after treatment, there were significant difference (P<0.01,P<0.02
respectively). Compared the course of improving 1 and 2 grades according to
Hughes scale of two groups, we found that the course of the combined group
41
was significantly shorter than that of the DXM group (P<0.01). The valid rate
of the combined group were slightly higher than that of the DXM group
( 90.63% and 82.85% respectively)when evaluated on the 21th day (P>0.05).
IVIG could alleviate dyspnea swiftly and could promote the recovery of MCV.
The risk of onset of side effects was 8.57% for DXM group, 9.37% for
combined group. No severe side effects appeared during treatment.
Conclusions: IVIG combined with GS on treating GBS excelled that
which using GS only on clinical effective time, on improving Hughes scale
and effective rate. IVIG combined
引文
[I] Ralf Gold, Frank Buttgereit, Klaus V.Toyka. et al. Mechanism of
action of glucocorticosteroid hormones: possible implications for therapy of
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[2] Onate SA, Tsai SY, Tsai MJ et al. Sequence and characterization of
a coactivator for the steroid hormone receptor superfamily.
Science, 1995,270:1354
[3] Buttgereit F, Buttgereit GR. A new hypothesis of modular
glucocorticoid actions -Steroid treatment of rheumatic disease revisited.
Arthritis Rheum, 1998,41:761
[4] Gametchu B. Glucocorticoid receptor-like antigen in lymphoma cell
membranes: correlation to cell lysis. Science,1987,236:456
[5] Dalakas MC. Intravenous immunoglobulin in the treatment of
autoimmune neuromuscular disease: present status and practical therapeutic
guidelines. Muscle Nerve 1999;22:1479~1497
[6] Tankersley DL, Preston MS, Finlayson JS. Immunoglobulin G dimer:
an idiotype—anti -idiotype complex. Mol Immunol 1988;25:41 ~48
[7] Roux KH, Tankersley DL. A view of the human idiotypic repertoire.
Electroc microscopic and immunologic analyses of spontaneous
idiotype-anti-idiotype dimers in pooled human IgG. J Immunol
1990;144:1387~1392
[8] Krause I, Blank M, Shoenfeld Y. Anti-DNA and antiphospholipid
antibodies in IVIG preparations: in vivo study in naive mice. J Clin Immunol
1998;18:52~60
[9] Malik U, Oleksowicz L, Latov N, Cardo LJ. Intravenous y-globulin
inhibits binding of anti-GMi to its target antigen. Ann Neurol 1996;39:136~
139
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intravenous immunoglobulin treatment on anti-GMj antibody-mediated
neuropathies. Journal of the Neurological Sciences, 1996; 139:160~ 162
[II] Dalakas MC. Blockade of blocking antibodies in Guillain-Barre
15
吉林大学硕士学位论文
syndromes:"unblocking" the mystery of action of IVIG. Ann Neurol
2002;51:667—669
[12] Buchwald B, Ahangari R, Weishaupt A, Toyka KV. Intravenous
immunoglobulins neutralize blocking antibodies in Guillain-Barre syndrome.
Ann Neurol 2002;51:673—680
[13] Ghetic V, Ward ES. FcRn: the MHC Class I-related receptor that is
more than an IgG transporter. Immunol Today 1997; 18:592—598
[14] Diegel M, Rankin B, Bolen J, Dubois P. Cross linking of Fc receptor
to surface immunoglobulin on B cells provides an inhibitory signal that closes
the plasma membrane calcium channel. J Biol Chem 1994;269:11409—11416
[15] D.E.Campbell, G.M.Georgion, A.S.Kemp. Pooled Human
Immunoglobulin Inhibits IL-4 But Not IFN-y OR TNF-a Secretion Following
In Vitro Stimulation OF Mononuclear Cells with Staphylococcal Superantigen.
CYTOKINE 1999; 11:359—365
[16] Kaveri S, Vassilev T, Hurex V, et al. Antibodies to a conserved
region of HLA class I molecules, capable of modulating CDg T cell-mediated
function, are present in pooled normal immunoglobulin for therapeutic use. J
Clin Invest 1996;97:868—869
[17] Murata K, Dalakas MC. Expression of the costimulatory molecule
BB-1, the ligands CTLA-4 and CD28, and their mRNA in chronic
inflammatory demyelinating polyneuropathy. Brain 2000; 123:1660— 1666
[18] Basta M, Ilia I, Dalakas MC. Increased in vitro uptake of the
complement C 35 in the serum of patients with Guillain Barre syndrome,
myasthenia gravis and dermatomyositis. J Neuroimmunol 1996;71:227—229
[19] Robert Rieben, Amout F. Gerritsen, Mohamed R Daha, et al. IgM
enriched IVIG preparations are efficient scavengers of C4 as well as Cj and
prevent complement-dependent cytotoxicity of human serum against pig cells.
Novel immunosupperessives and xenotransplantation. 25 June 1997 Oral
presentation 374
[20] Samuelsson A, Towers TL, Ravetch JV. Anti-inflammatory activity
of IVIG mediated through the inhibitory Fc receptor. Science 2001;291:484—
486
16
吉林大学硕士学位论文
[21] Suman K umari, Kailash C.Bhol, Farah Rehman, et al. Interleukin 1
components in cicatricial pemphigoid. Role in intravenous immunoglobulin
therapy. CYTOKINE 2001;14:218~224
[22] Sharief MK, Ingram DA, Swash M.Thompson EJ. IV
immunoglobulin reduces circulating proinflammatory cytokines in
Guillain-Barre syndrome. Neurology 1999;52:1833~1838
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metalloproteinase-9 and -7 are regulated in experimental autoimmune
encephalomyelitis. Brain 1998;121:159~166
[24] Kieseier BC, Tani M, Mahad D. et al. Chemokines and chemokine
receptors in inflammatory demyelinating neuropathies: a central role for IP-10.
Brain 2002;125:823—834
[25] Kazuhide Ochi, Tatsuo Kohriyama, Masahiro Higaki, etal. Changes
in serum macrophage-ralated factors in patients with chronic inflammatory
demyelinating polyneuropathy caused by intravenous immunoglobulin therapy.
Journal of the Neurological Science 2003;208:43~50
[26] Martin Stangel, Alastair Compston, Neil J. Scolding. Oligodendroglia
are protected from antibody-mediated complement injury by normal
immunoglobulins('TVTG"). Journal of the Neuroimmunology 2000; 103:
195-201
[27] Plasma Exchange/Sandoglobulin Guillain-Barre Syndrome Trial
Group. Randomised trial of plasma exchange, intravenous immunoglobulin,
and combined treatment in Guillain-Barre Syndrome.Lancet,!997,349:225~
30
[28] L-P.Zou, N.Abbas, I.Volkmann, et al. Suppression of experimental
autoimmune neuritis by ABR-215062 is associated with altered Th l/Th2
balance and inhibited migration of inflammatory cell into the perepheral nerve
tissue. Neuropharmacology, 2002,42:731~739
[29] M.Laura, N.A.Gregson, Y.Curmi, et al. Efficacy of leukemia
inhibitory factor in experimental autoimmune neuritis. Journal of
Neuroimmunology,2002,133:56~59
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neuroimmunological disorders. Journal of Neuroimmunology,2001,117:l~8
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Electroc microscopic and immunologic analyses of spontaneous
idiotype-anti-idiotype dimers in pooled human IgG. J Immunol
1990;144:1387~1392
[8] Krause I, Blank M, Shoenfeld Y. Anti-DNA and antiphospholipid
antibodies in IVIG preparations: in vivo study in naive mice. J Clin Immunol
1998;18:52~60
[9] Malik U, Oleksowicz L, Latov N, Cardo LJ. Intravenous y-globulin
inhibits binding of anti-GMi to its target antigen. Ann Neurol 1996;39:136~
139
[10] Nobuhiro Yuki, Fuminori Miyagi. Possible mechanism of
intravenous immunoglobulin treatment on anti-GMj antibody-mediated
neuropathies. Journal of the Neurological Sciences, 1996; 139:160~ 162
[II] Dalakas MC. Blockade of blocking antibodies in Guillain-Barre
15
吉林大学硕士学位论文
syndromes:"unblocking" the mystery of action of IVIG. Ann Neurol
2002;51:667—669
[12] Buchwald B, Ahangari R, Weishaupt A, Toyka KV. Intravenous
immunoglobulins neutralize blocking antibodies in Guillain-Barre syndrome.
Ann Neurol 2002;51:673—680
[13] Ghetic V, Ward ES. FcRn: the MHC Class I-related receptor that is
more than an IgG transporter. Immunol Today 1997; 18:592—598
[14] Diegel M, Rankin B, Bolen J, Dubois P. Cross linking of Fc receptor
to surface immunoglobulin on B cells provides an inhibitory signal that closes
the plasma membrane calcium channel. J Biol Chem 1994;269:11409—11416
[15] D.E.Campbell, G.M.Georgion, A.S.Kemp. Pooled Human
Immunoglobulin Inhibits IL-4 But Not IFN-y OR TNF-a Secretion Following
In Vitro Stimulation OF Mononuclear Cells with Staphylococcal Superantigen.
CYTOKINE 1999; 11:359—365
[16] Kaveri S, Vassilev T, Hurex V, et al. Antibodies to a conserved
region of HLA class I molecules, capable of modulating CDg T cell-mediated
function, are present in pooled normal immunoglobulin for therapeutic use. J
Clin Invest 1996;97:868—869
[17] Murata K, Dalakas MC. Expression of the costimulatory molecule
BB-1, the ligands CTLA-4 and CD28, and their mRNA in chronic
inflammatory demyelinating polyneuropathy. Brain 2000; 123:1660— 1666
[18] Basta M, Ilia I, Dalakas MC. Increased in vitro uptake of the
complement C 35 in the serum of patients with Guillain Barre syndrome,
myasthenia gravis and dermatomyositis. J Neuroimmunol 1996;71:227—229
[19] Robert Rieben, Amout F. Gerritsen, Mohamed R Daha, et al. IgM
enriched IVIG preparations are efficient scavengers of C4 as well as Cj and
prevent complement-dependent cytotoxicity of human serum against pig cells.
Novel immunosupperessives and xenotransplantation. 25 June 1997 Oral
presentation 374
[20] Samuelsson A, Towers TL, Ravetch JV. Anti-inflammatory activity
of IVIG mediated through the inhibitory Fc receptor. Science 2001;291:484—
486
16
吉林大学硕士学位论文
[21] Suman K umari, Kailash C.Bhol, Farah Rehman, et al. Interleukin 1
components in cicatricial pemphigoid. Role in intravenous immunoglobulin
therapy. CYTOKINE 2001;14:218~224
[22] Sharief MK, Ingram DA, Swash M.Thompson EJ. IV
immunoglobulin reduces circulating proinflammatory cytokines in
Guillain-Barre syndrome. Neurology 1999;52:1833~1838
[23] Kieseier BC, Kiefer R, Clements JM, et al. Matrix
metalloproteinase-9 and -7 are regulated in experimental autoimmune
encephalomyelitis. Brain 1998;121:159~166
[24] Kieseier BC, Tani M, Mahad D. et al. Chemokines and chemokine
receptors in inflammatory demyelinating neuropathies: a central role for IP-10.
Brain 2002;125:823—834
[25] Kazuhide Ochi, Tatsuo Kohriyama, Masahiro Higaki, etal. Changes
in serum macrophage-ralated factors in patients with chronic inflammatory
demyelinating polyneuropathy caused by intravenous immunoglobulin therapy.
Journal of the Neurological Science 2003;208:43~50
[26] Martin Stangel, Alastair Compston, Neil J. Scolding. Oligodendroglia
are protected from antibody-mediated complement injury by normal
immunoglobulins('TVTG"). Journal of the Neuroimmunology 2000; 103:
195-201
[27] Plasma Exchange/Sandoglobulin Guillain-Barre Syndrome Trial
Group. Randomised trial of plasma exchange, intravenous immunoglobulin,
and combined treatment in Guillain-Barre Syndrome.Lancet,!997,349:225~
30
[28] L-P.Zou, N.Abbas, I.Volkmann, et al. Suppression of experimental
autoimmune neuritis by ABR-215062 is associated with altered Th l/Th2
balance and inhibited migration of inflammatory cell into the perepheral nerve
tissue. Neuropharmacology, 2002,42:731~739
[29] M.Laura, N.A.Gregson, Y.Curmi, et al. Efficacy of leukemia
inhibitory factor in experimental autoimmune neuritis. Journal of
Neuroimmunology,2002,133:56~59