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신경질환에서 정맥주사용 면역글로불린 치료의 임상적 이용

Intravenous Immunoglobulin in the Treatment of Neurological Diseases

이영목|김세희
대한소아신경학회 (the Korean Child Neurology Society)|2018.03|대한소아신경학회지 (Journal of the korean child neurology society)|제26권 제1호|pp. 1-6|DOI 10.26815/jkcns.2018.26.1.1

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참고문헌

키워드

NeurologyIntravenous immunoglobulinGuillain–Barré syndrome
주제분류신경과학

초록

지난 오랜 기간 동안 여러 연구와 실험 보고는 정맥주사용 면역글로불린이 어떤 기전을 통하여 면역병리학적 반응을 완화시키는가에대한 우리의 이해를 확장시켜주었다. 정맥주사용 면역글로불린 치료는 자가 면역 질환 또는 길랭-바레 증후군, 만성 염증성 탈수초성 다발성 신경병증, 다초점성 운동신경병증과 같은 염증성 신경질환의 일차 또는 보조 치료제로 확고한 역할을 인정받고 있다. 다른 면역조절약제와 마찬가지로 일부 환자들에서는 정맥주사용 면역글로불린 치료에 반응을 보이지 않지만, 아직까지는 어떤 환자가 반응을 보일지에 대한 예측이 어렵다. 앞으로 치료 시작부터 반응을 예측할 수 있는변수나 요인에 대한 연구가 필요하지만, 현재까지는 더 추가적인 비교와 검증이 필요한 단계이다. 치료에 대한 반응을 확인하기 위한 임상시험을 더 정교하게 시행하려면, 임상적 경과를 반영할 수 있는 생체표지자를 찾고 개발하는 것도 중요하다. 더불어 새로운 동물 실험 모형은 인체 질환을 더 잘 반영하며 더 나은 임상실험의 설계는 정맥 주사용 면역글로불린이 어떻게 도움을 주는가에 대한 통찰을 가져다 줄것이다. 이런 노력들을 기반으로 가능성 있는 질환에 대한 추가적인적응증을 확보한다면, 그동안 난치성 질환으로 알려진 여러 환자들에서 더 정밀화된 면역치료의 길을 열어갈 수 있으리라 기대한다.

Abstract

Intravenous immunoglobulin (IVIG) is used in treating many cases of autoimmune and inflammatory conditions thanks to its multiple anti-inflammatory and immunomodulatory properties. The clinical use of IVIG has been for the patients with primary immunodeficiencies, but lately it is expanding its usage to the realms of treating patients with neurological conditions. Both the efficacy and safety of IVIG treatment in chronic inflammatory demyelinating polyradiculoneuropathy and Guillain–Barré syndrome have been studied successfully. However, the use of IVIG treatment in other neurological conditions still remains investigational despite several successful reports. Considerable numbers of mechanisms have been suggested in order to explain the effects of IVIG, but the exact mechanisms are not understood yet. This review covers the new developments in clinical fields and the possible ways in which IVIG could help in the future.

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