不同剂量吗替麦考酚酯治疗视神经脊髓炎谱系疾病的效果观察  

The observation of clinical and immunological parameters about different doses of mycophenolate mofetil in the treatment of neuromyelitis optica spectrum

作　　者：赵娜[1,2] 沙晶 玛依努尔·买买提[1,2] 李红燕 ZHAO Na;SHA Jing;Mahinur MAIMAITI;LI Hongyan(Department of Neurology,People’s Hospital of Xinjiang Uygur Autonomous Region,Urumqi,Xinjiang 830001,China;Xinjiang Clinical Research Center for Stroke and Neurological Rare Disease,Urumqi,Xinjiang 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院神经内科,新疆乌鲁木齐830001 [2]新疆脑卒中与神经系统罕见病临床医学研究中心,新疆乌鲁木齐830001

出　　处：《医药前沿》2023年第3期17-20,共4页Journal of Frontiers of Medicine

基　　金：新疆维吾尔自治区自然科学基金资助项目(2019D01C150);新疆维吾尔自治区人民医院科技引进创新项目(20200108)。

摘　　要：目的:观察不同剂量吗替麦考酚酯(MMF)治疗水通道蛋白-4抗体(AQP4-IgG)阳性的视神经脊髓炎谱系疾病(NMOSD)的临床疗效及外周血淋巴细胞亚群的变化。方法:选取2020年6月—2021年12月新疆维吾尔自治区人民医院神经内科收治的AQP4-IgG阳性NMOSD患者20例,缓解期使用MMF治疗。体重60 kg及以下的患者入MMF低剂量组(n=10):每日用量≤1000 mg;体重60 kg以上的患者入MMF中等剂量组(n=10):每日用量1250~1500 mg。观察两组患者治疗前后扩展残疾量表(EDSS)评分、年复发率(ARR)、外周淋巴细胞计数的变化。结果:在MMF治疗3、6、9、12个月后,两组患者的EDSS评分呈逐渐降低趋势,第12个月的EDSS评分、ARR均较治疗前明显下降,差异有统计学意义(P<0.05)。各时间点的两组EDSS评分、ARR比较,差异无统计学意义(P>0.05)。MMF治疗6~9个月后CD19+B淋巴细胞计数开始出现下降。随访期间2例患者出现轻微不良反应,在减少MMF用量后症状逐渐改善。结论:依据体重确定的不同MMF用量均可改善NMOSD预后;CD19+B淋巴细胞计数变化或可反映MMF疗效。Objective To evaluate the effectiveness of different doses of mycophenolate mofetil(MMF)in the treatment of neuromyelitis optica spectrum disorder(NMOSD)with seropositive Aquaporins4-IgG and the changes of lymphocyte subsets in peripheral blood after treatment.Method 20 patients with seropositive Aquaporins4-IgG were enrolled from department of neurology in People’s Hospital of Xinjiang Uygur Autonomous Region during June 2020 to Dec.2021.They were treated with MMF during the remission period.The dose of MMF was divided into low dose group and medium dose group according to the weight of patients.Patients weighing less than 60 kg were enrolled in low dose group:daily dosage≤1000 mg,patients weighing more than 60 kg were enrolled in the medium dose group:daily dose 1250-1500 mg,each group enrolled 10 patients.The changes of expanded disability statue scale(EDSS)score,ARR and peripheral lymphocyte count were observed before and after receiving MMF treatment.Results After the treatment of MMF,after 3,5,9 and 12 months the EDSS score and ARR in both groups decreased gradually compared with baseline.The EDSS score and annual recurrence rate(ARR)at the 12th month decreased significantly compared with those before treatment(P<0.05).There was no statistical difference between the two groups in EDSS score and ARR at the corresponding follow-up time(P>0.05).The count of CD19+B lymphocyte began to decline after 6-9 months of MMF treatment.During the follow-up period,2 patients had mild adverse reactions,the symptoms gradually improved after reducing the dosage of MMF.Conclusions The prognosis of NMOSD can be improved by different dosage of MMF according to weight;The count change of CD19+B lymphocyte may reflect the therapeutic effect of MMF.

关 键 词：视神经脊髓炎谱系疾病 AQP4-IgG 吗替麦考酚酯 淋巴细胞亚群 

分 类 号：R744.3[医药卫生—神经病学与精神病学]