Terapevtski učinek intravenskih imunoglobulinov na zmogljivost mišic zgornjih in spodnjih udov pri bolnikih z demielinizacijsko polinevropatijo : diplomsko delo

Prezelj, Eva (avtor), Leonardis, Lea (mentor)

Uvod: Kronične pridobljene demielinizacijske polinevropatije so heterogena skupina avtoimunih bolezni perifernega živčevja, za katere je značilna mišična šibkost in odziv na imunomodulatorno zdravljenje. Znotraj njih ločimo štiri skupine, ki se razlikujejo glede na razporeditev mišične prizadetosti, senzorični izpad in odgovor na imunomodulatorno zdravljenje. Za zdravljenje se trenutno med drugim pri vseh oblikah uporabljajo humani intravenski imunoglobulini. Čeprav veljajo za uspešno metodo pri zdravljenju, so do tedaj opravljene raziskave učinek vrednotile večinoma le z različnimi lestvicami, primanjkuje pa raziskav, ki bi učinek merile objektivno. Namen: Namen raziskave je bil kvantitativno izmeriti učinek intravenskih imunoglobulinov pri bolnikih z obliko kronične pridobljene demielinizacijske polinevropatije. Metode dela: V vzorec smo zajeli deset bolnikov z obliko kronične pridobljene demielinizacijske polinevropatije, ki redno prejemajo vzdrževalni odmerek intravenskih imunoglobulinov. Z ročnim dinamometrom MicroFET 2 in dinamometrom JAMAR® smo pred in en do dva tedna po aplikaciji zdravila izmerili izometrično mišično zmogljivost zgornjih in spodnjih udov bilateralno. Rezultate smo analizirali z Wilcoxonovim testom predznačenih rangov in t-testi za dva odvisna vzorca. Za analizo posameznika smo razliko izrazili v odstotkih. Zanimalo nas je, koliko mišičnih skupin se je pri posameznem bolniku izboljšalo za vsaj 25 % ali 50 %. Rezultati: Na drugo merjenje je prišlo osem od desetih bolnikov (starost 52,6±14,2 let), pet moških in tri ženske. Wilcoxonov test predznačenih rangov in analiza t-testov za dva odvisna vzorca nakazuje na učinkovitost zdravila. Na našem vzorcu sta se na zdravljenje pomembno odzvala dva od osmih, pri katerih se je za 50 % in več izboljšala vsaj polovica merjenih mišičnih skupin. Pri štirih bolnikih so bile opažene spremembe v smislu izboljšanja določenih mišičnih skupin, pri dveh bolnikih pa so bili rezultati po drugi meritvi slabši v primerjavi z merjenjem pred aplikacijo zdravila. Razprava in zaključek: Rezultati kažejo, da je v prihodnje smiselno poleg različnih lestvic bolnike dodatno spremljati še z ročno dinamometrijo. Naša raziskava, ki temu postavlja temelje, predlaga testne položaje in služi kot osnova nadaljnjemu intervalnemu spremljanju bolnikov. Zaradi majhnega vzorca preiskovancev in pomanjkanja normativov za zdrave mišične skupine, merjene z merilcem MicroFET 2, se odpira potreba po nadaljnjih raziskavah.

• Jezik: Slovenski jezik
• Ključne besede: vnetne polinevropatije, mišična zmogljivost, intravenski imunoglobulini, ročna dinamometrija
• Vrsta gradiva: Diplomsko delo/naloga
• Organizacija: ZF - Zdravstvena fakulteta
• Leto izida: 2018
• PID: 20.500.12556/RUL-102380
• COBISS.SI-ID: 5469035
• Datum objave v RUL: 24.08.2018

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Therapeutic effect of intravenous immunoglobulins on the upper and lower extremity muscle performance in patients with demyelinating polyneuropathy : diploma thesis

Izvleček

Introduction: Chronic acquired demyelinating polyneuropathies are a heterogeneous group of autoimmune diseases of peripheral nervous system characterized by muscular weakness and a response to immunomodulatory treatment. Among them, four groups that differ from each other according to the distribution of muscular impairment, sensory failure, and the response to immunomodulatory treatment are distinguished. Human intravenous immunoglobulins are currently most widely used for treatment of all forms. Although they are considered a successful treatment method, the results of various researches performed until then have been evaluated largely with help of different scales, but there is a lack of research that would measure the effect objectively. Purpose: The purpose of the study was to quantitatively measure the effect of intravenous immunoglobulins in patients with chronic demyelinating polyneuropathy. Methods: A sample of ten patients with a form of chronic acquired demyelinating polyneuropathy who regularly received a maintenance dose of intravenous immunoglobulins was captured. With the help of the hand dynamometer MicroFET 2 and the JAMAR® dynamometer, the isometric muscle performance of the upper and lower limbs was measured bilaterally before and within one to two weeks after administration. The results were analysed by Wilcoxon signed-rank test and paired t-tests. For the analysis of the individual, the difference was expressed in percentage. We were interested in how many muscle groups improved for at least 25 % or 50 % in each patient. Results: The second measurement attended eight out of ten patients (age 52,6±14,2), five men and three women. Wilcoxon signed-rank test and paired t-tests suggest the effectiveness of the drug. On our sample, two out of eight responded significantly to treatment with at least half of the measured muscle groups having improved by 50 % or more. In four patients changes were observed in terms of the improvement of certain muscle groups, and in two patients, the results after the second measurement were worse compared to the pre-treatment measurements. Discussion and conclusion: The results show that in the future it is reasonable to monitor patients with objective hand-held dynamometry in addition to different scales. Our research, which sets the foundation for this, proposes test positions and serves as a basis for further interval monitoring of patients. Due to a small sample of subjects and lack of normative value for healthy muscle groups measured with a MicroFET 2 dynamometer, there is a need for further research.

• Ključne besede: inflammatory polyneuropathies, muscle performance, intravenous immunoglobulin, hand-held dynamometry