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用抗CD20疗法治疗的患者的西尼罗病毒神经侵入性疾病

Rumyar V Ardakani^1,2, Paul Daniel Crane^1,3, Daniel M Pastula^1,4,5

¹Department of Neurology, University of Colorado School of Medicine, Aurora, CO.

Neurology. Clinical practice

|June 30, 2025

概括

西尼罗神经侵入性疾病 (WNND) 在接受抗CD20疗法的患者中造成显著残疾. 反转录PCR (RT-PCR) 对于诊断WNND在这个人群中至关重要,因为WNV IgM测试不可靠.

科学领域:

神经免疫学神经免疫学
传染性疾病传染性疾病
在瘤学瘤学.

背景情况:

对于接受抗CD20治疗的患者的严重西尼罗病毒神经侵入性疾病 (WNND) 有有限的数据.
在接受B细胞消耗治疗的患者中,鉴别WNND病例至关重要.

研究的目的:

在第三级学术卫生系统中,在接受抗CD20治疗的患者中系统地描述WNND病例.
评估这个特定患者队列的诊断方法和临床结果.

主要方法:

从2016年1月到2024年1月的回顾性队列研究.
电子病历查询,然后对WNND和抗CD20使用的患者进行个人病历审查.
分析临床表现,诊断结果 (CSF WNV IgM,RT-PCR),成像,治疗和结果 (mRS,死亡率).

主要成果:

确定了25名患者,52%患有多发性硬化症,作为抗CD20治疗的指示.
84%的患者出现脑膜炎;CSFRT-PCR在93%的测试患者中呈阳性,而WNV IgM仅在24%的患者中呈阳性.
75%的人经历了残疾累积 (mRS增加≥1点),8%的人在90天内死亡.

结论:

在接受抗CD20疗法的患者中,WNND显著导致残疾.
由于WNV IgM测试的敏感性较低,RT-PCR是该人群中WNND的重要诊断工具.
早期和准确的诊断对于在免疫受损患者中管理WNND至关重要.

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