他克莫司治疗激素依赖性重症肌无力的疗效观察  

Clinical efficacy of tacrolimus in prednisone-dependent patients with generalized myasthenia gravis

作　　者：陈玉萍[1] 李月敏[2] 王卫[1] 王中魁[1] 魏东宁[1] 张娟[1] 

机构地区：[1]解放军309医院神经内科,北京100091 [2]解放军309医院放疗科,北京100091

出　　处：《解放军医学杂志》2015年第1期46-49,共4页Medical Journal of Chinese People's Liberation Army

基　　金：首都临床特色应用研究(Z121107001012060)~~

摘　　要：目的评价他克莫司治疗激素依赖性重症肌无力（MG）的疗效。方法观察激素依赖性全身型MG患者74例,34例接受他克莫司治疗（2~6mg/d）,40例接受硫唑嘌呤治疗（150mg/d）,比较两组治疗前及治疗后1、3、6、12个月时MG严重程度评分,同时记录他克莫司治疗组服用激素的剂量及不良反应。结果与治疗前（18.2±9.1）相比,接受他克莫司治疗后1、3、6、12个月MG临床相对评分（分别为13.4±6.5、10.7±4.6、8.7±3.7、5.3±2.1）显著降低,差异有统计学意义（P〈0.01）;而硫唑嘌呤组治疗6个月、12个月后较治疗前差异有统计学意义（P〈0.05）。他克莫司治疗后1,3、6、12个月临床总有效率（临床相对评分≥25%）分别为65.3%、77.6%、81.2%及85.8%,显著高于硫唑嘌呤组（分别为12.3%、25.4%、56.7%及75.6%）。患者服用他克莫司后3、6、12个月激素减停率分别为8.8%、32.4%及70.6%,激素不良反应从94.1%下降为14.7%（P〈0.01）。结论对于激素依赖性全身型MG患者,他克莫司疗效优于硫唑嘌呤,且可明显降低患者对激素的依赖。Objective To evaluate the efficacy oftacrolimus in patients with prednisone-dependent generalized myasthenia gravis （MG）. Methods A total of 74 patients with prednisone-dependent generalized MG received either tacrolimus （FK506） （n=34） or azathioprine （n=40） for more than 12 months. The daily dosage and adverse reaction of tacrolimus or azathioprine used in these two groups were recorded, and the therapeutic effect of the drugs and the clinical scores of MG were evaluated and compared between the two groups before treatment and at 1, 3, 6 and 12 months after treatment. Results Compared with that of before treatment （18.2±9.1）, clinical relative scores of MG decreased significantly in tacrolimus group at 1, 3, 6 and 12 months after its treatment （13.4 ± 6.5, 10.7 ±4.6, 8.7 ±3.7 and 5.3 ± 2.1, respectively） （P〈0.01）. While in azathioprine group, the significant differences in efficiency appeared only 6 and 12 months after azathioprine treatment （P〈0.05）. The total clinical efficacy （clinical relative score ~ 25%） in tacrolimus group were 65.3%, 77.6%, 81.2% and 85.8%, respectively at 1, 3, 6 and 12 months after treatment, and it was significantly higher than that in azathioprine group （12.3%, 25.4%, 56.7% and 75.6%, respectively）. Prednisone decrement rate in tacrolimus group was 8.8%, 32.4% and 70.6%, respectively at 3, 6 and 12 months after treatment, and the rate of prednisone- related adverse effects decreased from 94.1% at baseline to 14.7% at the final visit （P〈0.01）. Conclusion The therapeutic effect of tacrolimus is clearly superior to that of azathioprine for the prednisone-dependent generalized MG patients, and it significantly reduces the dependence of patients on prednisone.

关 键 词：重症肌无力 他克莫司 硫唑嘌呤 激素依赖 免疫抑制剂 

分 类 号：R746.1[医药卫生—神经病学与精神病学]