Zdravljenje avtoimunih demielinizacijskih polinevropatij s subkutanimi imunoglobulini : diplomsko delo

Kavšek, Vesna (avtor), Leonardis, Lea (mentor), Puh, Urška (recenzent)

Uvod: Avtoimunske demielinizacijske polinevropatije so redka oblika bolezni, pri kateri imunski sistem napade lastni periferni živčni sistem in povzroči demielinizacijo, lahko celo izgubo aksonov. Z zgodnjo diagnozo in ustreznim zdravljenjem lahko preprečimo dolgotrajno poškodbo živcev in funkcijske okvare. Večina bolnikov se dobro odzove na zdravljenje z imunoglobulini, ki so jih v preteklosti dovajali intravensko, v zadnjih letih pa se uveljavlja podkožna terapija. Ta večini bolnikom izboljša kakovost življenja in omeji pojav resnih stranskih učinkov. Namen: Želeli smo kvantitativno izmeriti učinkovitost zdravljenja demielinizacijskih polinevropatij s podkožnim dovajanjem imunoglobulinov in rezultate primerjati z rezultati v času zdravljenja z intravenskimi imunoglobulini. Metode dela: V raziskavi smo šest mesecev spremljali potek podkožnega zdravljenja 11 bolnikov z diagnozo kronične vnetne demielinizacijske polinevropatije ali multifokalne motorične nevropatije. Funkcijska testiranja (test vstani in pojdi, ocena globalne nezmožnosti), senzorično oceno INCAT, jakost prijema roke in uščipa ter oceno mišic zgornjih in spodnjih udov po MRC lestvici smo izvedli ob uvedbi nove terapije, 1., 3. in 6. mesec podkožne terapije z imunoglobulini. Rezultate testiranja ob uvedbi in po 3. oziroma 6. mesecu terapije smo statistično analizirali z dvostranskim t-testom: parametrične podatke z D'Agostino & Pearson testom in neparametrične z Wilcoxonovim parnim testom predznačenih rangov. Spremembo splošnega stanja preiskovanca smo določili na podlagi vsaj dveh klinično pomembnih sprememb meritev (odstopanja za vsaj 25 %) ob odsotnosti druge vrste klinično pomembne spremembe. Rezultati: Rezultati funkcijskih testiranj, senzorične ocene, mišične jakosti v času zdravljenja s subkutanimi imunoglobulini se niso razlikovali glede na vrednosti pri zdravljenju z intravenoznimi imunoglobulini (pridobljene s testiranjem ob uvedbi podkožne terapije). Rezultati kažejo na izboljšanje stanja petih preiskovancev, poslabšanje pri enem in nespremenjeno stanje ostalih petih preiskovancih. Razprava in zaključek: Ugotavljamo, da sta podkožna in intravenska terapija pri bolnikih z demielinizacijskimi polinevropatijami primerljivi. Razlike med posamezniki so prisotne, zato je pri izbiri terapije pomembna individualizacija odmerka in način zdravljenja. V Sloveniji je bilo predhodno za takšne bolnike uveljavljeno le zdravljenje z intravenskimi imunoglobulini, s pozitivnimi rezultati naše raziskave pa lahko na tem področju pričakujemo uveljavitev podkožne terapije.

• Jezik: Slovenski jezik
• Ključne besede: diplomska dela, fizioterapija, polinevropatije, imunoglobulini, intravenska terapija, podkožna terapija
• Vrsta gradiva: Diplomsko delo/naloga
• Tipologija: 2.11 - Diplomsko delo
• Organizacija: ZF - Zdravstvena fakulteta
• Kraj izida: Ljubljana
• Založnik: [V. Kavšek]
• Leto izida: 2021
• Št. strani: 40 str., [9] str. pril.
• PID: 20.500.12556/RUL-133052
• UDK: 615.8
• COBISS.SI-ID: 84286723
• Datum objave v RUL: 09.11.2021

KAVŠEK, Vesna, 2021, Zdravljenje avtoimunih demielinizacijskih polinevropatij s subkutanimi imunoglobulini : diplomsko delo [na spletu]. Diplomsko delo. Ljubljana : V. Kavšek. [Dostopano 3 april 2025]. Pridobljeno s: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=slv&id=133052

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Treatment of autoimmune demyelinating polyneuropathy with subcutaneous immunoglobuline : diploma work

Izvleček

Introduction: Autoimmune demyelinating polyneuropathy is a fairly rare form of the disease in which the immune system attacks its own peripheral nervous system and causes demyelination, possibly even loss of axons. With early diagnosis and appropriate treatment, long-term nerve damage and functional impairment can be prevented. Most patients respond well to treatment with immunoglobulins that have been administered intravenously in the past, and subcutaneous therapy has been gaining ground in recent years. It improves the quality of life for most patients and limits the occurrence of serious side effects. Purpose: We wanted to quantitatively measure the effectiveness of treatment of demyelinating polyneuropathy with subcutaneous administration of immunoglobulins and compare the results with the results during treatment with intravenous immunoglobulins. Methods: We monitored the course of subcutaneous treatment of 11 patients (diagnosed with chronic inflammatory demyelinating polyneuropathy or multifocal motor neuropathy) for up to six months. Functional tests (get up and go test, overall disability sum score), INCAT sensory sum score, dynamometry (grip and pinch strength) and muscle strength testing according to the MRC scale were performed with the introduction of a new therapy, the first, third and sixth month of subcutaneous therapy with immunoglobulins. The test results at the introduction and after 3 and 6 months of therapy were statistically analyzed with a bilateral t-test: parametric data with the D'Agostino & Pearson test and non-parametric with the Wilcoxon signed-rank test of predicted ranks. The change in the general condition of the subject was determined on the basis of at least two clinically significant changes in measurements (deviations of at least 25 %) in the absence of another type of clinically significant change. Results: The results of functional tests, INCAT sensory evaluation, dynamometry, and muscle strength measured in subcutaneous therapy did not differ statistically from values monitored in time of intravenous immunoglobulin therapy (the values measured at introduction of a new therapy). The results show an improvement in the condition of 5/11 patients, a deterioration in 1/11 and an unchanged condition of the other 5 patients. Discussion and conclusion: Based on the results of statistical analysis and clinical changes, we conclude that subcutaneous and intravenous therapy in patients with demyelinating polyneuropathy are comparable. Differences between individuals are present, so dose individualization and route of administration are important when choosing therapy. In Slovenia, only treatment with intravenous immunoglobulins was previously established for such patients, and with the positive results of our research, we can expect the introduction of subcutaneous therapy in this field.

• Ključne besede: diploma theses, physiotherapy, polyneuropathy, immunoglobulins, intravenous therapy, subcutaneous therapy