A型肉毒毒素注射治疗锥体外系疾病合并眼睑痉挛的疗效观察  

Efficacy of botulinum toxin type A injection for treatment of blepharospasm in extrapyramidal disease

作　　者：王蕾[1] 高源[1] 陈生弟[1] 肖勤[1] 王瑛[1] 刘军[1] 张璟[1] 袁华强[1] 吴逸雯[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院神经内科上海交通大学医学院神经病学研究所,上海200025

出　　处：《内科理论与实践》2016年第2期65-68,共4页Journal of Internal Medicine Concepts & Practice

基　　金：国家自然科学基金青年科学基金(项目编号:81200981);上海市教育委员会科研创新项目(自然科学类)(项目编号:13YZ026);上海交通大学"医工(理)交叉研究基金"项目(项目编号:YG2010MS19);上海市科学技术委员会科研计划项目(项目编号:14XD1402700)

摘　　要：目的:探讨A型肉毒毒素(Bo NT/A)注射治疗锥体外系疾病合并眼睑痉挛(伴或不伴睁眼性失用)的疗效。方法:30例锥体外系疾病(19例帕金森病、5例多系统萎缩、6例进行性核上性麻痹)合并眼睑痉挛的患者局部注射Bo NT/A,在治疗前和治疗后1个月采用Jankcovic评定量表(JRS)、眼睑痉挛残疾指数(BSDI)评估眼睑痉挛改善效果,视觉模拟评分法(VAS)让患者自评疗效,自评改善大于50%定义为治疗有效。结果:治疗后1个月患者JRS-F(1.43±0.68)分、JRS-S(1.23±0.94)分、JRS-T(2.53±1.46)分、BSDI(1.33±0.91)分,均较治疗前[JRS-F(2.47±0.90)分、JRSS(2.70±0.88)分、JRS-T(5.30±1.68)分、BSDI(1.95±0.83)分]明显降低,差异均有统计学意义(均P<0.001)。86.7%的患者治疗有效(VAS评分大于50%),治疗无效的13.3%患者均伴发睁眼性失用。结论:Bo NT/A能有效治疗锥体体外系疾病合并眼睑痉挛,但对伴发睁眼性失用的患者疗效有限。Objective To investigate the efficacy of botulinum toxin type A（Bo NT/A） injection for the treatment of blepharospasm（with or without apraxia of lid opening） in extrapyramidal disease.Methods Thirty patients of extrapyramidal disease（19 Parkinson＇s disease,5 multiple system atrophy,6 progressive supranuclear palsy） were recruited in the study.Eligible patients were injected with Bo NT/A.Patients were assessed at baseline,immediately prior to receiving the injection,and were re-assessed one month after the injection.Assessment was performed using questionnaires comprising Jankcovic rating scale（JRS） and blepharospasm disability index（BSDI） to evaluate blepharospasm.Visual analog scales（VAS） was used to self-evaluate the response of the injection.Efficacy in outcome was the rate of responders defined as an improvement of at least 50%.Results At 1 month after the Bo NT/A injection,the JRS and BSDI（1.43 ±0.68,1.23±0.94,2.53±1.46,1.33±0.91） decreased significantly as compared with baseline（2.47 ±0.90,2.70 ±0.88,5.30±1.68,1.95±0.83）（all P〈0.001）;86.7% patients（VAS〉50%） had subjective improvement of blepharospasm and the rest were blepharospasm with apraxia of lid opening.Conclusions Bo NT/A injection might be an effective treatment for blepharospasm in extrapyramidal disease,but had limited efficacy for those with apraxia of lid opening.

关 键 词：锥体外系疾病 眼睑痉挛 睁眼性失用 A型肉毒毒素 

分 类 号：R777.1[医药卫生—眼科] R741[医药卫生—临床医学]