中等剂量地塞米松与甲强龙冲击治疗重症肌无力疗效观察  

Clinical observation of short-duration moderate dose dexamethasone followed by slowly tapering to the lower maintenance dose prednisone therapy for myasthenia gravis

作　　者：毛梅[1] 王丽芳[1] 吴秀娟[1] 张宇[1] 邓晖[1] 刘亢丁[1] 

机构地区：[1]吉林大学白求恩第一医院神经内科,吉林长春130021

出　　处：《中风与神经疾病杂志》2015年第12期1112-1115,共4页Journal of Apoplexy and Nervous Diseases

摘　　要：目的比较中等剂量地塞米松与大剂量甲强龙冲击治疗后，小剂量强的松维持治疗重症肌无力的疗效及安全性，探讨糖皮质激素治疗重症肌无力的最佳剂量及副作用。方法将43例成人全身型重症肌无力患者分为A、B两组，A组为中等剂量地塞米松加小剂量强的松维持治疗组，共30例；B组为大剂量甲强龙冲击治疗后加小剂量强的松维持治疗组，共13例。治疗前及治疗后1m、3m根据重症肌无力定量评分量表（quantitive MG score，QMGs）分别进行评分以判定疗效，同时记录激素相关不良反应。结果A组与B组治疗后1m有效率分别为83％及85％；治疗后3m有效率均为100％；治疗后3m痊愈＋基本痊愈率分别为50％及30％，上述差异均无统计学意义。应用激素早期（4-10d）症状加重评分分别为（o．77±1．04）及（0．70±0．95），P〉0．05；3m内不良反应发生率分别为14％及24％，P〈0．05。结论中等剂量地塞米松加小剂量强的松维持治疗方案与甲强龙冲击治疗加小剂量强的松维持方案治疗效果相当，但前者不良反应发生率更低，更宜于在临床中推广。Objective To compare the efficacy and side effects of moderate dosage dexamethasone （DEX） with methylprednisolone （MP） pulse therapy both followed by slowly tapering to maintenance dosage prcdnisone in adult patients with generalized myasthenia gravis （GMG）. Methods Forty-three patients were divided into two groups, 30 patients in group A were treated with moderate dosage DEX, 13 patients in group B were treated with MP pulse therapy. The clinical score was recorded based on quantitative MG score （QMGs） at pretreatment, the 1 st and 3rd month posttreatment. The side effects of glucocorticoid （GC） were also recorded simultaneously. Results Efficacy percentages of A and B groups at the 1 st month posttreatment were 83 % and 85 %, P 〉 0.05 （P = 1.00 ）, while at the 3 rd month both reached 100%. The clinical remission and basic remission percentages of A and B groups were 50% and 30% , with no statistical significance. Side effects score in 10 days posttreatment were （0.77 ±1.04） and （ 0.70 ±0.95 ）, P 〉 0.05 （ P = 0. 826 ）. Side effects percentages of the two groups at the 3rd month posttreatment were 14% and 24% ,P 〈 0.05 （P = 0. 037 ）. Conclusion DEX therapy had an equal efficacy and less side effects when compared with MP therapy. DEX therapy is more suitable to be applied in clinical treatment.

关 键 词：重症肌无力 糖皮质激素 地塞米松 甲基强地松龙 

分 类 号：R746.1[医药卫生—神经病学与精神病学]