悬壶记事

前些天有个年轻MS(multiple sclerosis）女病人因准备怀孕来就诊。

说就诊是因为有MS病史。

病人2012年因右侧视神经炎就诊，脑脊髓MRI呈明显典型MS状，腰穿都免了就诊断为MS。病人先上了治MS的Copaxone, 因为期间反复relapsing, 换成Tysabri infusion x 1.5年。期间仍是反复复发，遂往芝加哥西北大学神内，又被推荐到了hematology 的Richard K. Burt, MD, 著名的运用自身造血干细胞移植技术治疗MS及多种自身免疫性疾病的先驱。病人在充分评估后进行了自身造血干细胞移植HSCT並成功至今，再无复发，MRI跟踪自移植数年以来再无影像新的病灶发现。

这是我看到的做了HSCT的二例MS病人中“治愈”的案例。另一例很多年前因美国不开展跑去墨西哥做的，后来沒有随访不知道情况如何。

病人说Dr. Burt 搬去了加州圣地亚哥，所以她想在本地先找好一个神内医生，万一怀孕后MS有复发可以迅速就诊。

病人是老师，这个HSCT很鼓舞人！

上网搜索一下，Dr. Burt确实是跨界大牛。血液科医生治神内的MS，还有其它自身免疫性疾病。

当代生物医学进步，认识到人的很多疾病都与自身免疫系统功能失调有关。

HSCT就是重置reset自身免疫系统功能,使其重新正常工作。

就如IVIG通用于许多自身免疫性疾病一样，只是手段不同罢了。

医学的进步，归根结底取决于基础科学的研究突破。

Hematopoietic stem cell transplantation (HSCT), also known as bone marrow transplantation (BMT), is a treatment option for severe autoimmune diseases:
How it works
HSCT aims to treat autoimmune diseases by replacing the body's autoreactive immune cells with a new, self-tolerant immune system. This can lead to lasting remissions and disease control.
Conditions treated
HSCT is used to treat a variety of autoimmune diseases, including:
Multiple sclerosis (MS)
Systemic lupus erythematosus (SLE)
Inflammatory bowel disease (CD)
Rheumatoid arthritis (RA)
Type 1 diabetes
Risks and considerations
HSCT is associated with short-term risks, including infection, bleeding, anemia, organ toxicities, and treatment-related mortality. The risk of complications is higher with allogeneic and autologous HSCT.

Patient selection
HSCT requires careful patient selection and a multidisciplinary team of hematology and autoimmune disease specialists. Candidates should be without severe organ damage and have good heart, lung, and kidney function.

Outcomes
HSCT can induce long-term sustained remission in patients with MS. Patients with autoimmune disorders can return to their normal lives and most remain in remission.

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