健脾益气补肝健肾中药治疗重症肌无力眼肌型患儿的乙酰胆碱受体抗体的临床研究  

Research of Strengthening Spleen and Replenishing Qi and Tonifying Liver and Invigorating Kidney Chinese Medical Prescription on Acetylcholine Receptor Antibody Concentration for Ocular Myasthenia Gravis Children

作　　者：乞国艳[1] 刘鹏[1] 顾珊珊[1] 薛银萍[1] 刘朝英[1] 董会民[1] 杨红霞[1] 

机构地区：[1]石家庄市第一医院重症肌无力诊疗中心,河北石家庄050011

出　　处：《中华中医药学刊》2017年第3期624-628,共5页Chinese Archives of Traditional Chinese Medicine

基　　金：河北省自然科学基金项目(H2015106020);河北省科技计划项目(14277758D);河北省中医药管理局项目(2014221);第三批河北省中医药管理局重症肌无力脾胃虚损证重点研究项目;石家庄市科技局指导项目(131460613)

摘　　要：目的:1统计重症肌无力(MG)眼肌型患儿乙酰胆碱受体抗体的阳性率;2评价和探讨健脾益气补肝健肾中药治疗肾上腺糖皮质激素治疗复发或无效的重症肌无力眼肌型(MGI型)患儿的临床疗效,以及疗效与乙酰胆碱受体抗体(Ach R-Ab)之间的关系。方法:选择2010年5月—2015年1月就诊于石家庄市第一医院住院或门诊的明确诊断重症肌无力眼肌型、发病年龄小于15岁、肾上腺糖皮质激素治疗无效或复发的患儿149例,单纯接受我院健脾益气补肝健肾为主方的中药治疗,在治疗前、后1、3、6、12个月时应用重症肌无力许氏绝对与相对评分法评价重症肌无力症状的严重程度[1],同时检测治疗前和治疗后1、3、6、12个月外周血液中乙酰胆碱受体抗体的滴度。结果:1149例患儿中,98例乙酰胆碱受体抗体阳性的患儿,占65.77%;51例阴性的患儿,占34.23%。2乙酰胆碱受体抗体阳性与阴性患儿在治疗后1、3、6、12个月时临床相对评分≥75%(有效率)的患儿相比较有显著性差异(P<0.05),到12个月时Ach R-Ab阳性患儿达到98.9%,阴性患儿达90.9%,有统计学意义;3相对评分≥90%(临床痊愈率)的患儿在1、3、6、12个月时相比有显著性差异(P<0.05),到12个月时Ach R-Ab阳性患儿达到97.8%,阴性患儿达88.0%,有统计学意义。4乙酰胆碱受体抗体阳性患儿的Ach RAb滴度治疗后3、6、12个月与治疗前相比有显著性差异(P<0.05),有统计学意义;经两两比较,治疗后3个月与治疗前患儿Ach R-Ab滴度比较差异无统计学意义(P>0.05),其余组内两两比较均有统计学意义(P<0.05);12个月时Ach R-Ab滴度由(3.40±2.08)nmmol/L下降至(0.38±1.08)nmmol/L,有统计学意义。结论:本组研究乙酰胆碱受体抗体阳性患儿阳性率65.77%;健脾益气补肝健肾中药治疗乙酰胆碱受体抗体阳性的重症肌无力眼肌型患儿的总有效率和临床痊愈率均高于Ach R-Ab阴性的患儿;乙酰胆碱受体抗体阳性眼�Objective：（1）To count up the acetylcholine receptor antibody positive rate of myasthenia gravis （MG） children with eye muscle type. （2）To observe the clinical effect of strengthening spleen and replenishing Qi and tonifying liver and invigorating kidney prescription on ocular myasthenia gravis children patients who were recurrence or ineffective by glucocorticoid therapy. To analyze the acetylcholine receptor antibody concentration in peripheral blood. Methods：The retrospective data of 149 patients with childhood - onset ocular MG（ age of MG onset was less than 15 years） who were re- currence or ineffective by glucocorticoid therapy were collected from Department of myasthenia gravis in The First Hospital of Shijiazhuang（January 2010 -Janum7 2015 ）. The patients were treated by strengthening spleen and replenishing Qi and tonifying liver and invigorating kidney prescription. The MG absolute and relative clinical scores were used to monitor the efficacy of treatment. Clinical evaluations were conducted before, and at 1,3,6 and 12 months after treatment. The acetylcholine receptor antibody concentration in the development was observed before and 12 months after treatment to analyze the immune adjustment. Results ：（1）In 149 cases ,98 cases of children patients＇ acetylcholine receptor antibody were positive ,accounting for 65.77%. Fifty - one cases of children patients＇ acetylcholine receptor antibody were negative,accounting for 34.23%. （2）With MG score for disease severity after accepting the pure traditional Chinese medicine, the clinical effective rates of two groups （MG relative clinical score ≥ 90% ） were respectively significant at 1,3,6 and 12 months（P 〈 0. 05）. By 12 months, the children with positive AchR -Ab reached 97.8% and those with the negative AchR- Ab reached 88%. There were significant differences. （2）The acetylcholine receptor antibody concentrations were respectively significant decreased in 1,3,6 and 12 months after accepting the pure traditi

关 键 词：健脾益气补肝健肾中药(JPYQBGJS) 重症肌无力眼肌型(MG1型) 乙酰胆碱受体抗体(AchR-Ab) 临床绝对和相对评分 

分 类 号：R746.1[医药卫生—神经病学与精神病学]