小剂量激素联合免疫抑制剂在Ⅰ、Ⅱ型重症肌无力患者中的疗效观察及对细胞免疫水平的影响研究  

Therapeutic effect of low-dose hormone combined with immunosuppressive agents in patients with type Ⅰ and Ⅱ myasthenia gravis and its effect on cellular immunity

作　　者：孙静洁[1] 王琪[1] SUN Jing-Jie;WANG Qi(Lanzhou University Second Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院

出　　处：《中国免疫学杂志》2019年第21期2628-2632,共5页Chinese Journal of Immunology

基　　金：兰州市科技计划项目(No.2015-2-54)资助

摘　　要：目的:探讨小剂量激素联合免疫抑制剂在重症肌无力患者中的临床效果及对细胞免疫水平的影响。方法:选择2016年5月~2018年2月来本院治疗的Ⅰ、Ⅱ型重症肌无力患者84例为研究对象,电脑抽取随机数字法分为对照组(n=42)和观察组(n=42)。对照组给予溴吡斯的明与泼尼松治疗,观察组在对照组基础上联合硫唑嘌呤治疗,比较两组重症肌无力症状评分、细胞免疫水平及药物安全性。结果:观察组治疗后复视、面肌、咀嚼、吞咽、睑下垂、发音、左上肢、右上肢、头部、左下肢、右下肢及呼吸肌功能评分均高于对照组(P<0.05);观察组治疗后CD3^+、CD4^+、CD4^+/CD8^+水平均低于对照组(P<0.05);观察组治疗后CD8^+水平高于对照组(P<0.05);观察组与对照组治疗后消化道症状、高血压、体重异常、感染及高血脂发生率差异无统计学意义(P>0.05)。结论:小剂量激素联合硫唑嘌呤片用于治疗Ⅰ、Ⅱ型重症肌无力,有助于改善患者症状,降低细胞免疫水平,并未增加药物不安全性,值得推广应用。Objective:To investigate the clinical effects of low-dose hormone combined with immunosuppressive agents in patients with myasthenia gravis and the effect on cellular immunity.Methods: Eighty-four patients with type Ⅰ and type Ⅱ myasthenia gravis who were treated from May 2016 to February 2018 were enrolled.The subjects were randomly divided into the control group(n=42) and the observation group(n=42) by computer.The control group was treated with bromide and prednisone.The observation group was treated with azathioprine on the basis of the control group.The scores of myasthenia gravis,cellular immunity and drug safety were compared between the two groups.Results: The scores of double vision,facial muscle,chewing,swallowing,sag,pronunciation,left upper limb,right upper limb,head,left lower limb,right lower limb and respiratory muscle were significantly higher in the observation group than in the control group(P<0.05).The levels of CD3^+,CD4^+ and CD4^+/CD8^+ in the observation group were lower than those in the control group(P<0.05).The level of CD8^+ in the observation group was higher than that in the control group(P<0.05).There was no significant difference in the incidence of gastrointestinal symptoms,hypertension,abnormal body weight,infection and hyperlipidemia(P>0.05).Conclusion: Low-dose steroid combined with azathioprine tablets in the treatment of patients with type Ⅰ and Ⅱ myasthenia gravis can improve the symptoms of patients and reduce the level of cellular immunity.It does not increase drug insecurity and is worthy of popularization and application.

关 键 词：激素 硫唑嘌呤片 重症肌无力 症状评分 细胞免疫水平 药物安全性 

分 类 号：R741[医药卫生—神经病学与精神病学]