短程大剂量糖皮质激素冲击联合其他免疫抑制剂治疗重症肌无力的疗效观察  

Therapeutic efficacy and safety of high-dose intravenous glucocorticosteroids combined with other immunosuppressants in myasthenia gravis:a report of 40 patients

作　　者：李尊波 熊葶 刘建军[1] 朱婷鸽[1,2] 朱可[1,3] 沈定国[1] 许贤豪[4] 

机构地区：[1]西安高新医院神经内科,710075 [2]第四军医大学唐都医院神经内科肌电图室 [3]中国医科大学附属盛京医院 [4]北京医院神经内科,100730

出　　处：《中国神经免疫学和神经病学杂志》2015年第1期16-19,共4页Chinese Journal of Neuroimmunology and Neurology

基　　金：国家临床重点专科建设项目

摘　　要：目的评价短程大剂量糖皮质激素(GCS)冲击联合其他免疫抑制剂治疗重症肌无力(MG)的疗效及安全性。方法回顾性分析作者医院2003-11-2011-2期间住院的40例应用短程大剂量GCS冲击联合其他免疫抑制剂治疗MG患者的疗效和不良反应,比较不同治疗时段、性别、起病年龄、临床类型、免疫抑制剂的疗效。结果与治疗前比较,所有病例在短程大剂量GCS冲击联合其他免疫抑制剂治疗4周时临床绝对评分显著改善(6.88±6.97 vs.24.50±10.78,P<0.01),治疗12个月时与治疗4周时临床绝对评分无统计学差异(7.22±10.39 vs.6.88±6.97,P>0.05);治疗4周时的相对评分69.00%±27.53%、有效率92.50%,治疗12个月时的相对评分70.00%±39.35%、有效率87.50%。其治疗4周时与治疗12个月时的有效率在不同性别、起病年龄、眼肌型/全身型的比较中均无统计学差异(P>0.05)。治疗4周时环孢素组的有效率优于硫唑嘌呤组(P<0.05),治疗12个月时此2组有效率无统计学差异(P>0.05)。结论短程大剂量GCS冲击联合免疫抑制剂治疗可显著改善MG患者临床表现。Objective To examine the therapeutic efficacies and side effects of high-dose intravenous glucocorticosteroids（GCS）combined with other immunosuppressants in myasthenia gravis（MG）.MethodsHigh-dose intravenous GCS and additional immunosuppressants were administrated to 40 MG patients.The clinical score was recorded to assess the therapeutic efficacy.Results All the cases showed significant improvement 4weeks after the treatment（6.88±6.97 vs.24.50±10.78,P〈0.01）.There was no difference of therapeutic efficacies between 4weeks and 12 months after the treatment（7.22±10.39 vs.6.88±6.97,P〉0.05）.The relative score was 69.00%±27.53% and the improving rate was 92.50% after treated for 4weeks.The relative score was 70.00%±39.35% and the improving rate was 87.50% after treated for 12 months.No significant difference of the improving rate was found between different age,sex,ocular MG/generalized MG groups（both 4weeks and 12 months after the treatment）（P〉0.05）.Cyclosporine A group was superior to azathioprine A group in the improving rate after treated for 4weeks（P〈0.05）,and no significant difference was found in the two groups after treated for 12months（P〉0.05）.Conclusions High-dose intravenous GCS and additional other immunosuppressants can improve symptoms of MG.

关 键 词：重症肌无力 糖皮质激素 免疫抑制剂 

分 类 号：R746.1[医药卫生—神经病学与精神病学]