他克莫司治疗重症肌无力的效果及对AchR-Ab的影响  

Efficacy of tacrolimus in treating myasthenia gravis and how to impact on AchRAb

作　　者：赵帅 颜聪亚 乞国艳 潘祖林 刘鹏 薛银萍 王雅璇 ZHAO Shuai;YAN Congya;QI Guoyan(Department of Oncology,Shijiazhuang People’s Hospital,Hebei,Shijiazhuang 050030,China;不详)

机构地区：[1]河北省石家庄市人民医院针灸科,050030 [2]河北省重症肌无力诊疗中心

出　　处：《河北医药》2022年第22期3413-3415,3419,共4页Hebei Medical Journal

基　　金：河北省石家庄市科学技术研究与发展指导计划(编号:181461143);河北省省级科技计划资助项目(编号:19277701D);河北省自然科学基金资助项目(编号:H2019106063)。

摘　　要：目的研究单药他克莫司治疗重症肌无力(myasthenia gravis,MG)的疗效、对乙酰胆碱受体(acetylcholine receptor,AChR)抗体滴度的影响。方法回顾性分析了2019年2月至2021年2月单药他克莫司治疗MG患者68例。口服7~10 d后检测他克莫司血药浓度,根据结果调整他克莫司剂量,使其最终血药浓度维持在5~10 nmol/L。分析他克莫司治疗MG的疗效、不良反应,并观察AchR-Ab滴度的变化。结果68例患者中,45例有效,有效率66.2%;总蛋白水平、白蛋白、总胆固醇、高密度脂蛋白、CD19^(+)百分比、CD4/CD8比值治疗前后差异无统计学意义(P>0.05)。与治疗前比较,肌酐、CD_(3)^(+)百分比下降,差异有统计学意义(P<0.05)。治疗后的血常规中的淋巴细胞计数较治疗前上升,差异有统计学意义(P<0.05)。他克莫司治疗期间,共有6例患者出现不良反应,发生率为8.8%;其中血糖升高2例,腹泻共2例,白细胞轻微下降1例,肾功能异常1例。患者的不良反应经过对症处理或者或药物减量后均可缓解,没有因严重的不良反应而停药。他克莫司治疗的68例MG患者中,AchR-Ab滴度较治疗前明显降低,差异有统计学意义(P<0.05)。结论单药他克莫司治疗重症肌无力的有效率较高,且不良反应少,为受限于糖皮质激素治疗的患者提供了新方法;同时他克莫司可使AChR-Ab水平的下降,可能进一步解释了他克莫司治疗重症肌无力的机制。Objective To study the efficacy of tacrolimus in treating myasthenia gravis(MG)and how to impact on anti-acetylcholine receptor antibody(anti-AChR-Abs)titer.Methods MG patients(n=68)treated with tacrolimus from February 2019 to February 2021 were retrospectively enrolled.The blood concentration of tacrolimus was detected in 7~10 days of oral administration,and tacrolimus dose-adjusted concentrations based on the outcome to maintain the final plasma concentration within 5~10nmol/L.The efficacy and treatment-emergent adverse events were(TEAEs)assessed,and the change in anti-AChR-Abs titer was recorded.Results There are 66.2%(45/68)for effective rate.No differences in the total protein level,albumin,total cholesterol,high-density lipoprotein,CD19^(+)ratio,and CD4/CD8 ratio between before and after treatment were statistically significant(P>0.05).The percentage of creatinine and CD_(3)^(+)decreased significantly compared with before treatment(P<0.05).The lymphocyte count in the blood routine test elevated significantly after treatment as compared to before treatment(P<0.05).TEAE rates were 8.8%(6/68),wherein,2 cases for blood glucose,2 cases for diarrhea,1 case for slight decreases with white blood cells,and 1 case for abnormal renal function.The TEAEs had alleviated by symptomatic treatment or dosage reduction,and no drug discontinuance was made due to serious adverse reactions.The post-treatment anti-AChR-Abs titers of 68 MG patients were significantly superior to pre-treatment(P<0.05).Conclusion Tacrolimus mono-therapy delivers higher response rate for MG with lower side effects,presenting a new method for patients limited by glucocorticoid therapy.Moreover,tacrolimus is capable of elevating the level of anti-AChR-Abs titer,further explaining the mechanism of tacrolimus in the treatment of myasthenia gravis.

关 键 词：重症肌无力 他克莫司 乙酰胆碱受体抗体 治疗 疗效 

分 类 号：R746.1[医药卫生—神经病学与精神病学]