[周围神经免疫疾病--神经病理学见解和临床视角]。

IF 0.9 4区 医学 Q4 CLINICAL NEUROLOGY Nervenarzt Pub Date : 2024-10-01 Epub Date: 2024-09-20 DOI:10.1007/s00115-024-01725-2
Sarah Hoffmann, Marie-Therese Holzer, Corinna Preuße, Tobias Ruck, Nikolas Ruffer, Frauke Stascheit, Werner Stenzel
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引用次数: 0

摘要

本文论述了周围神经免疫疾病,并简要概述了当前最重要的方面和治疗进展。特发性炎症性肌病的发病机制、表现和预后各不相同。新的分类系统和更具体的治疗概念已经形成。特发性炎症性肌病包括不同的亚组。这些疾病都有特定的自身抗体。在诊断方面,肌肉活检通常是精确诊断的理想方法,对于不明确的病例来说,肌肉活检是必不可少的。原发性系统性血管炎可根据主要受累模式分为不同的组别,而继发性血管炎和单器官血管炎也有区别。血管炎性肌病不能等同于肌炎,目前只有通过肌肉活检才能进行可靠的区分。应在跨学科的基础上制定治疗方案。慢性炎症性脱髓鞘性多发性神经病是最常见的免疫介导型神经病,其特点是运动神经和感觉神经脱髓鞘为主。该病的病程呈阶段性或进行性发展,会导致严重的残疾和生活质量下降,尽管目前采用了标准治疗方法。新的治疗方法目前正在进行临床试验。肌无力症的主要症状是运动引起的肌无力,是由针对神经肌肉终板结构的自身抗体引起的。自身抗体检测是诊断中最重要的支柱,现在也越来越多地指导治疗决策。总体而言,外周神经免疫疾病是一个异质性的群体。对病理生理学的进一步了解是诊断和治疗领域取得众多进展的关键,这可能会在未来带来意义深远的实际变化。
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[Peripheral neuroimmunological diseases - Neuropathological insights and clinical perspectives].

This article deals with peripheral neuroimmunological diseases and briefly outlines the currently most important aspects and treatment developments. Idiopathic inflammatory myopathies have different mechanisms of development, manifestations and prognoses. New classification systems and more specific treatment concepts have been developed. The IIMs include different subgroups. These entities can have specific autoantibodies. Diagnostically, a muscle biopsy is generally desirable for a precise diagnosis and is essential in unclear cases. Primary systemic vasculitides can be divided into different groups based on the predominant pattern of involvement, while secondary vasculitides and single organ vasculitides are also differentiated. Vasculitic myopathy cannot be equated with myositis and a reliable distinction is currently only possible by a muscle biopsy. Treatment concepts should be developed on an interdisciplinary basis. Chronic inflammatory demyelinating polyneuropathy is the most frequent immune-mediated neuropathy and is characterized by a predominant demyelination of the motor and sensory nerves. The disease course runs in phases or is progressive and leads to significant disability and reduction in quality of life, despite current standard treatment. Novel treatment approaches are currently undergoing clinical trials. Myasthenia gravis, with the leading symptom of exercise-induced muscle weakness, is caused by autoantibodies against structures of the neuromuscular endplate. Autoantibody testing is the most important pillar in the diagnosis and is now also increasingly guiding treatment decisions. Overall, peripheral neuroimmunological diseases represent a heterogeneous group. Increasing knowledge of the pathophysiology is the key to numerous developments in diagnostics and treatment, which could lead to far-reaching practical changes in the future.

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来源期刊
Nervenarzt
Nervenarzt 医学-精神病学
CiteScore
2.50
自引率
18.20%
发文量
169
审稿时长
4-8 weeks
期刊介绍: Der Nervenarzt is an internationally recognized journal addressing neurologists and psychiatrists working in clinical or practical environments. Essential findings and current information from neurology, psychiatry as well as neuropathology, neurosurgery up to psychotherapy are presented. Review articles provide an overview on selected topics and offer the reader a summary of current findings from all fields of neurology and psychiatry. Freely submitted original papers allow the presentation of important clinical studies and serve the scientific exchange. Review articles under the rubric ''Continuing Medical Education'' present verified results of scientific research and their integration into daily practice.
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