免疫球蛋白联合糖皮质激素治疗老年重症肌无力患者的临床观察  

Clinical efficacy and safety of intravenous immunoglobulin combined with glucocorticoid in the treatment of myasthenia gravis in elderly patients

作　　者：闫芳[1] 臧卫周[1] 孟祺 姚勇[1] 徐军[1] 张杰文[1] Yan Fang;Zang Weizhou;Meng Qi;Yao Yong;Xu Jun;Zhang Jiewen(Department of Neurology, Henan People＇s Hospital, Zhengzhou 450013, China)

机构地区：[1]河南省人民医院神经内科,郑州450013

出　　处：《中华老年医学杂志》2018年第4期398-400,共3页Chinese Journal of Geriatrics

摘　　要：目的探讨静脉注射免疫球蛋白联合糖皮质激素治疗老年重症肌无力患者的临床疗效。方法选取我院2012年1月至2016年12月神经内科就诊的235例老年重症肌无力患者，按照随机数字表法将其分为观察组117例和对照组118例。对照组给予糖皮质激素治疗，观察组给予静脉注射免疫球蛋白联合糖皮质激素治疗，比较两组患者临床疗效、免疫功能指标、美国重症肌无力协会定量（QMG）评分、症状缓解时间、住院时间及不良反应。结果观察组治疗总有效率高于对照组（106/117、90.6%和84/118、71.2%，χ2＝5.621，P＝0.000）。观察组血清IgG1、IgG3、补体C3水平高于对照组（均P〈0.05）。QMG评分、症状缓解时间和住院时间观察组分别为（9.2±4.0）分、（6.2±1.6）d和（14.4±3.3）d，优于对照组的（13.4±6.1）分、（11.6±2.4）d和（25.1±4.8） d，（t＝6.158、19.797和20.078，P＝0.000、0.002和0.009）。两组均未出现严重不良反应。结论老年重症肌无力患者应用静脉注射免疫球蛋白联合糖皮质激素治疗效果显著，可及时控制病情进展，调节免疫功能，缩短住院时间，是该病目前比较理想的治疗方案。ObjectiveTo investigate the effectiveness and safety of intravenous immunoglobulin combined with oral glucocorticoid in the treatment of myasthenia gravis in elderly patients.MethodsA total of 235 elderly patients diagnosed as myasthenia gravis in our hospital were enrolled in our study from January 2012 to December 2016, and randomly divided into observation group （intravenous immunoglobulin combined with oral glucocorticoid n=118） and control group （oral glucocorticoid only, n=117）. The clinical curative effect, immune function index, QMG scale, symptom remission time, length of hospitalization, and adverse reactions in both groups were recorded and analyzed after two-week treatment.ResultsThe total effective rate was significantly higher in observation group （106/117, 90.6%） than in control group （84/118, 71.2%） （χ2=5.621, P=0.000）. The levels of serum IgG1, IgG3, and complement C3 were significantly higher in observation group than in control group （P〈0.05）. The QMG scale, symptom remission time, and length of hospitalization were lower in observation group [（9.2±4.0） score, （6.2±1.6） d, （14.4±3.3） d] than in the control group [（13.4±6.1） score, （11.6±2.4） d, （25.1±4.8） d] （t=6.158, 19.797, and 20.078, P=0.000, 0.002 and 0.009）. No serious adverse reaction was observed in both groups.ConclusionsThe combined therapies of intravenous immunoglobulin and oral glucocorticoid for myasthenia gravis in the elderly have remarkable effectiveness.It is close to an ideal treatment because it effectively inhibits a disease progression in time, regulates an immune function, and shortens a hospitalization time.

关 键 词：免疫球蛋白类 糖皮质激素类 重症肌无力 静脉内注射 

分 类 号：R746.1[医药卫生—神经病学与精神病学]