吗替麦考酚酯治疗伴其他自身抗体阳性视神经脊髓炎谱系疾病的疗效  

Clinical efficacy of mycophenolate mofetil in treatment of neuromyelitis optica spectrum disorder with other positive autoantibodies

作　　者：李妙嫦 王玉鸽[1] 李蕊[1] 杨渝[1] 邱伟[1] 卢婷婷[1] Li Miaochang;Wang Yuge;Li Rui;Yang Yu;Qiu Wei;Lu Tingting(Department of Neurology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院神经科,广州510630 [2]肇庆市第一人民医院神经科,肇庆526011

出　　处：《新医学》2020年第3期190-194,共5页Journal of New Medicine

基　　金：广东省自然科学基金(2017A030313853)。

摘　　要：目的比较免疫抑制剂吗替麦酚酯(MMF)治疗伴或不伴其他自身抗体阳性的视神经脊髓炎谱系疾病(NMOSD)患者的疗效。方法将90例NMOSD患者分为伴有其他自身抗体阳性组(阳性组)及不伴有其他自身抗体阳性组(阴性组),比较2组患者在接受MMF治疗前后的扩展残疾状态量表(EDSS)评分、年平均复发率(ARR)。结果纳入的90例患者中,6例因不良反应退出研究,6例因检查欠配合、复诊不及时等原因被剔除,共78例患者(阳性组30例、阴性组48例)被纳入统计。78例患者治疗时间12~39.7月。阳性组与阴性组治疗前及治疗后各时间段的EDSS评分组间比较差异均无统计学意义(P均>0.05)。2组治疗后30 d、90 d、180 d、360 d的EDSS评分均较治疗前低(P均<0.05/4),治疗后的前6个月阳性组下降幅度较阴性组明显,治疗6个月后阴性组的下降幅度较阳性组明显。2组治疗时间比较差异无统计学意义(P>0.05)。治疗期间阳性组有9例出现复发,共复发12次,阴性组有12例出现复发,共复发16次。与治疗前比较,阳性组及阴性组治疗后的ARR均降低(P均<0.01)。治疗前及治疗后2组ARR比较差异无统计学意义(P均>0.05)。结论MMF对伴或不伴有其他自身抗体阳性的NMOSD患者均有效。Objective To compare the clinical efficacy of mycophenolate mofetil(MMF) in the treatment of neuromyelitis optica spectrum disorder(NMOSD) with or without other positive autoantibodies. Methods All 90 NMOSD patients were divided into the positive and negative autoantibody groups. The expanded disability status scale(EDSS) score and mean annual recurrence rate(ARR) were statistically compared between two groups before and after receiving MMF treatment. Results Among 90 patients, 6 patients withdrew from the study due to adverse reactions and 6 patients were excluded due to lack of cooperation in examination and follow-up. A total of 78 patients(n = 30 in the positive group and n = 48 in the negative group) were included in subsequent statistical analysis. The treatment time of 78 cases was ranged from 12.0 to 39.7 months. The EDSS scores did not significantly differ between two groups at each time point before and after treatment(all P > 0.05). In both groups, the EDSS scores were significantly decreased at 30, 90, 180 and 360 d after corresponding treatment(all P < 0.05/4). Within 6 months after treatment, the decrease trends of EDSS score in the positive group was more evident compared with that in the negative group. At 6 months after treatment, the decline of EDSS score in the negative group was more evident compared with that in the positive group. The treatment time did not significantly differ between two groups(P > 0.05). Throughout the treatment, 9 patients recurred for 12 times in the positive group, and 12 cases recurred for16 times in the negative group. After treatment, the ARR was significantly decreased in both groups(both P < 0.01). The ARR did not significantly differ between two groups before and after MMF treatment(both P > 0.05). Conclusion MMF shows equivalent clinical efficacy in the treatment of NMOSD with and without other positive autoantibodies.

关 键 词：视神经脊髓炎谱系疾病 自身抗体 吗替麦考酚酯 疗效 

分 类 号：R744.52[医药卫生—神经病学与精神病学]