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中华临床医师杂志(电子版) ›› 2017, Vol. 11 ›› Issue (18) : 2241 -2244. doi: 10.3877/cma.j.issn.1674-0785.2017.18.007

所属专题: 文献

综述

妊娠期视神经脊髓炎谱系疾病的研究进展
石冰心1, 赵忙所2, 乔立艳2, 耿同超2,()   
  1. 1. 100084 北京,清华大学医学中心
    2. 100040 北京,清华大学附属玉泉医院神经内科
  • 收稿日期:2016-10-31 出版日期:2017-09-15
  • 通信作者: 耿同超
  • 基金资助:
    北京市自然科学基金资助项目(7164268)

Progress in research of neuromyelitis optica spectrum disorders in pregnancy

Bingxin Shi1, Mangsuo Zhao2, Liya Qiao2, Tongchao Geng2,()   

  1. 1. Medical Center, Tsinghua University, Beijing 100084, China
    2. Department of Neurology, Yuquan Hospital, Tsinghua University , Beijing 100040, China
  • Received:2016-10-31 Published:2017-09-15
  • Corresponding author: Tongchao Geng
  • About author:
    Corresponding author: Geng Tongchao, Email:
引用本文:

石冰心, 赵忙所, 乔立艳, 耿同超. 妊娠期视神经脊髓炎谱系疾病的研究进展[J]. 中华临床医师杂志(电子版), 2017, 11(18): 2241-2244.

Bingxin Shi, Mangsuo Zhao, Liya Qiao, Tongchao Geng. Progress in research of neuromyelitis optica spectrum disorders in pregnancy[J]. Chinese Journal of Clinicians(Electronic Edition), 2017, 11(18): 2241-2244.

视神经脊髓炎谱系疾病(neuromyelitisopticaspectrum disorder,NMOSD)是一种以体液免疫为主要机制的中枢神经系统脱髓鞘疾病,多见于育龄期女性。妊娠被认为是NMOSD复发的可能危险因素,很多女性患者因为顾虑疾病的复发加重而被建议禁止妊娠。随着临床工作的积累和对该病研究的不断进展,我们发现,NMOSD患者在使用激素和/或免疫抑制药物下可以安全妊娠,并将对胎儿的的损害控制到最低水平。疾病活动期采取避孕措施,病情稳定半年后再受孕,妊娠期及产后维持预防复发的修饰治疗可能是合理的。

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory demyelinating disorder of the central nervous system characterized by recurrent optic neuritis and longitudinal extensive transverse myelitis. It frequently occurs in childbearing-age women. Pregnancy is regarded as a possible independent risk factor for disease relapse. Many female patients were advised not to be pregnant, given concerns about disease exacerbation. With the accumulation of clinical experience and the progress in research of this disease, we found that NMOSD patients could have safe pregnancies with minimum damage to the fetus under reasonable planning and effective immunosuppressive treatments. Conceiving after remission for at least six months and maintaining immunotherapy during pregnancy and postpartum periods may be helpful to decrease the risk of pregnancy-related relapse.

[1]
Jurewicz A, Selmaj K. Relapse of neuromyelitis optica during pregnancy-treatment options and literature review [J]. Clin Neurol Neurosurg, 2015, 130: 159-161
[2]
Wingerchuk DM, Lennon VA, Lucchinetti CF, et al. The spectrum of neuromyelitis optica [J]. Lancet Neurol, 2007, 6(9): 805-815.
[3]
Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders [J]. Neurology, 2015, 14, 85(2): 177-189.
[4]
Cutolo M, Brizzolara R, Atzeni F, et al. The immunomodulatory effects of estrogens: clinical relevance in immune-mediated rheumatic diseases [J]. Ann N Y Acad Sci, 2010, 1193: 36-42.
[5]
Saito S, Sakai M, Sasaki Y, et al. Quantitative analysis of peripheral blood Th0, Th1, Th2 and the Th1: Th2 cell ratio during normal human pregnancy and preeclampsia [J]. Clin Exp Immunol, 1999, 117(3): 550-555.
[6]
Davoudi V, Keyhanian K, Bove RM, et al. Immunology of neuromyelitis optica during pregnancy [J]. Neurol Neuroimmunol Neuroinflamm, 2016, 3(6): e288.
[7]
Bourre B, Marignier R, Zephir H, et al. Neuromyelitis optica and pregnancy [J]. Neurology, 2012, 78(12): 875-879.
[8]
Kim W, Kim SH, Nakashima I, et al. Influence of pregnancy on neuromyelitis optica spectrum disorder [J]. Neurology, 2012, 78(16): 1264-1267.
[9]
Fragoso YD, Adoni T, Bichuetti DB, et al. Neuromyelitis optica and pregnancy [J]. J Neurol,2013, 260(10): 2614-2619.
[10]
Nour MM, Nakashima I, Coutinho E, et al. Pregnancy outcomes in aquaporin-4-positive neuromyelitis optica spectrum disorder [J]. Neurology, 2016, 86(1): 79-87.
[11]
Chan WF, Gurnot C, Montine TJ, et al. Male microchimerism in the human female brain [J]. PLoS One, 2012, 7(9): e45592.
[12]
Tan XW, Liao H, Sun L, et al. Fetal microchimerism in the maternal mouse brain: a novel population of fetal progenitor or stem cells able to cross the blood-brain barrier [J]? Stem Cells, 2005, 23(10): 1443-1452.
[13]
Hedlund E, Hefferan MP, Marsala M, et al. Cell therapy and stem cells in animal models of motor neuron disorders [J]. Eur J Neurosci, 2007, 26(7): p. 1721-1737.
[14]
Ferguson TA and Elman LB. Clinical presentation and diagnosis of amyotrophic lateral sclerosis [J]. NeuroRehabilitation, 2007, 22(6): 409-416.
[15]
Kenner M, Menon U and Elliott DG. Multiple sclerosis as a painful disease [J]. Int Rev Neurobiol, 2007, 79: 303-321.
[16]
Zhang G, Zhao Y, Li XM, et al. Fetal cell microchimerism in the maternal mouse spinal cord [J]. Neurosci Bull, 2014, 30(1): 81-89.
[17]
Saadoun S, Waters P, Leite MI, et al. Neuromyelitis optica IgG causes placental inflammation and fetal death [J]. J Immunol, 2013, 191(6): 2999-3005.
[18]
Gunaydin B, Akcali D, and Alkan M. Epidural anaesthesia for caesarean section in a patient with Devic′s Syndrome [J]. Anaesthesia, 2001, 56(6): 565-567.
[19]
Sinha A and Bagga A. Pulse steroid therapy [J]. Indian journal of pediatrics, 2008, 75(10): 1057-66.
[20]
Stangel M, Baumann U, Borte M, et al. Treatment of neurological autoimmune diseases with immunoglobulins: first insights from the prospective SIGNS registry [J]. J Clin Immunol, 2013, 33 Suppl 1: S67-71.
[21]
Okada K, Tsuji S and Tanaka K. Intermittent intravenous immunoglobulin successfully prevents relapses of neuromyelitis optica [J]. Intern Med, 2007, 46(19): 1671-1672.
[22]
Rubio Tabares J, Amaya Gonzalez PF. Plasma exchange therapy for severe relapse of Devic′s disease in a pregnant woman: A case report andconcise review [J]. Clin Neurol Neurosurg, 2016, 148: 88-90.
[23]
Koh JH, Ko HS, Lee J, et al. Pregnany and patients with preexisting lupus nephritis: 15 years of experience at a single center in Korea [J]. Lupus. 2015, 24(7): 764-772.
[24]
Carmichael SL, Shaw GM, Ma C, et al. Maternal corticosteroid use and orofacial clefts [J]. Am J Obstet Gynecol, 2007, 197(6): 585.e1-585.
[25]
Hosseini-Carroll P, Mutyala M, Seth A, etal. Pregnancy and inflammatory bowel diseases: Current perspectives, risks and patient management [J]. World J Gastrointest Pharmacol Ther, 2015, 6(4): 156-171.
[26]
Lannes G, Elias FR, Cunha B, et al. Successful pregnancy after cyclophosphamide therapy for lupus nephritis [J]. Arch Gynecol Obstet, 2011, 283(Suppl 1): 61-65.
[27]
Weber-Schoendorfer C, Chambers C, Wacker E, et al. Pregnancy outcome after methotrexate treatment for rheumatic disease prior to or during early pregnancy: a prospective multicenter cohort study [J]. Arthritis Rheumatol, 2014, 66(5): 1101-1110.
[28]
Cassina M, Johnson DL, Robinson LK, et al. Pregnancy outcome in women exposed to leflunomide before or during pregnancy [J]. Arthritis Rheum, 2012, 64(7): 2085-2094.
[29]
Friedrichs B, Tiemann M, Salwender H, et al. The effects of rituximab treatment during pregnancy on a neonate [J]. Haematologica, 2006, 91(10): 1426-147.
[30]
Goldstein LH, Dolinsky G, Greenberg R, et al. Pregnancy outcome of women exposed to azathioprine during pregnancy [J]. Birth Defects Res A Clin Mol Teratol, 2007, 79(10): 696-701.
[31]
Plauborg AV, Hansen AV and Garne E. Use of azathioprine and corticosteroids during pregnancy and birth outcome in women diagnosed with inflammatory bowel disease [J]. Birth Defects Res A Clin Mol Teratol, 2016, 106(6): 494-499.
[32]
Ponticelli C and Moroni G. Immunosuppression in pregnant women with systemic lupus erythematosus [J]. Expert Rev Clin Immunol, 2015, 11(5): 549-552.
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