[神经脊髓炎视谱系疾病诊断错误导致错误治疗和患者病情恶化]。

Q3 Medicine
O V Boyko, M A Omarova, V V Gosteva, A A Kuznetsov, A N Boyko
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引用次数: 0

摘要

神经脊髓炎视谱系疾病(NMOSD)是一组罕见的神经免疫性疾病,主要累及视神经和脊髓,其次累及大脑,会引起严重的病情加重,导致患者持续残疾。多年来,视神经脊髓炎一直被认为是多发性硬化症(MS)病程中预后不利的变异型,然而 2004 年,在这类患者中发现了水蒸发蛋白-4 的特异性自身抗体,从而有可能将 NMOSD 分离成 MS 以外的另一类脱髓鞘疾病。由于临床症状相似且病程以缓解为主,通常很难做出正确的诊断并据此开出有效的治疗处方,这往往导致在诊断错误的情况下选择了错误的治疗方法。在某些情况下,这会导致 NMOSD 病程恶化。我们介绍了一例晚期诊断 NMOSD 的病例,该病例证实患者在使用阿仑妥珠单抗作为高度活动性缓解型多发性硬化症的高效疗法的第一个疗程后 2 个月出现病情加重。及时诊断 NMOSD 可以排除此类病例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Mistakes in the diagnosis of neuromyelitis optic spectrum diseases lead to wrong therapy and deterioration of patients' condition].

Neuromyelitis optic spectrum diseases (NMOSD) are a group of rare neuroimmunological diseases involving mainly the optic nerves and spinal cord, to a lesser extent the brain, and causing severe exacerbations that lead to persistent disability of patients. For many years, opticoneuromyelitis was considered a prognostically unfavorable variant of the course of multiple sclerosis (MS), however, in 2004, specific autoantibodies to aquaporin-4 were found in such patients, which made it possible to isolate NMOSD into a separate group of demyelinating diseases other than MS. Due to similar clinical signs and the predominantly remitting course of diseases, it is often difficult to make a correct diagnosis and, accordingly, prescribe effective therapy, which often leads to incorrectly selected therapy with incorrect diagnosis. In some cases, this leads to a worsening of the course of NMOSD. We present a case of late diagnosis of NMOSD that confirms the development of exacerbation in the patient 2 months after the first course of therapy with alemtuzumab prescribed as a highly effective therapy for highly active remitting MS. Timely diagnosis of NMOSD makes it possible to exclude such cases.

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来源期刊
CiteScore
1.10
自引率
0.00%
发文量
287
审稿时长
3-6 weeks
期刊介绍: Одно из старейших медицинских изданий России, основанное в 1901 году. Создание журнала связано с именами выдающихся деятелей отечественной медицины, вошедших в историю мировой психиатрии и неврологии, – С.С. Корсакова и А.Я. Кожевникова. Широкий диапазон предлагаемых журналом материалов и разнообразие форм их представления привлекают внимание научных работников и врачей, опытных и начинающих медиков, причем не только неврологов и психиатров, но и специалистов смежных областей медицины.
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