局部注射A型肉毒毒素治疗视神经脊髓炎谱系疾病伴发瘙痒效果观察  

Efficacy of local injection of botulinum toxin type A on pruritus associated with neuromyelitis optica spectrum disorder

作　　者：孟祺 朱明芳 时英英 谭蕾蕾 张亚坤 黄展 李鹏辉 孙争宇 张杰文 黄月 MENG Qi;ZHU Mingfang;SHI Yingying;TAN Leiei;ZHANG Yakun;HUANG Zhan;LI Penghui;SUN Zhengyu;ZHANG Jiewen;HUANG Yue(Department of Neurology,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan450003,China)

机构地区：[1]河南省人民医院神经内科郑州大学人民医院,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2025年第2期174-178,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划省部共建项目(SBGJ202102038)。

摘　　要：目的 探讨局部注射A型肉毒毒素(BTX-A)治疗视神经脊髓炎谱系疾病(NMOSD)伴发瘙痒的效果及安全性。方法 2023年7—12月河南省人民医院诊治NMOSD伴发瘙痒患者3例,均行水通道蛋白4抗体检测,记录患者临床资料及MRI检查、腰椎穿刺、抗核抗体(ANA)+抗可提取性核抗原(ENA)抗体检测结果,采用局部皮下注射BTX-A(每个注射点间隔1.5~2.0 cm,每个注射点注射2 u BTX-A)治疗瘙痒,治疗前及治疗后1、2、4、8、12周采用瘙痒数字评分量表评估瘙痒程度,记录患者注射时及注射后疼痛、出血、皮肤发红、颈部无力、肌肉萎缩、吞咽困难等不良反应发生情况。结果 3例患者临床表现均为右侧颈肩部瘙痒,患者1、2为NMOSD首次发作,以瘙痒起病;患者3为NMOSD复发,病程中出现瘙痒症状。3例患者水通道蛋白4抗体均阳性,患者1合并ANA 1∶320、SSA(+)、Ro52(+),患者2、3 ANA+ENA抗体检测均未见异常。3例患者MRI均可见长节段颈髓病变伴强化,腰椎穿刺脑脊液压力均正常,脑脊液细胞数均轻度增高;患者1脑脊液蛋白轻度增高,患者2、3蛋白正常。3例患者皮下注射BTX-A治疗后瘙痒减轻,治疗1、2、4、8周瘙痒数字评分量表评分逐渐降低,8~12周趋于稳定;注射时及注射后均未发生明显不良反应。结论 局部皮下注射BTX-A治疗NMOSD伴发瘙痒可有效减轻瘙痒,无明显不良反应。Objective To explore the efficacy and safety of local injection of botulinum toxin type A(BTX-A)in the treatment of pruritus associated with neuromyelitis optica spectrum disorder(NMOSD).Methods Three NMOSD patients with pruritus were treated in Henan Provincial People's Hospital from July to December 2023.Aquaporin-4 antibody was tested,and the clinical data,MRI examinations,lumbar puncture,and anti-nuclear antibody(ANA)+extractable nuclear antigen(ENA)antibody test results were recorded.Local subcutaneous injection of BTX-A(2 u BTX-A at each injection site,with a 1.5-2.O cm interval between each site)was done to treat pruritus.The degree of pruritus was assessed using the numerical rating scale before treatment and after 1-,2-,4-,8-and 12-week treatment.The adverse reactions such as pain,bleeding,skin redness,neck weakness,muscle atrophy and swallowing difficulties during and after injection were recorded.Results All three patients presented with pruritus on the right neck and shoulder.Patient 1 and 2 experienced their first episode of NMOSD,with pruritus as the initial symptom.Patient 3 had a relapse of NMOSD and developed pruritus during the course of the disease.Aquaporin-4 antibody was positive in all patients.Patient 1 had additional ANA 1:320,SSA(+),and Ro52(+),while patient 2 and 3 showed no abnormalities in ANA+ENA antibodies.MRI scans revealed long segment cervical spinal cord lesions with enhancement in all patients.Lumbar puncture showed the cerebrospinal fluid(CSF)pressure was normal,and the cell counts in CSF increased slightly.Patient 1 had a mild increase in CSF protein,while patient 2 and 3 had normal CSF protein level.After subcutaneous injection of BTX-A,pruritus was alleviated,and the numberical rating scale scores decreased gradually after 1-,2-,4-and 8-week treatment and kept stable from 8 to 12 weeks.No obvious adverse reactions were found during and after injection.Conclusion Local subcutaneous injection of BTX-A can effectively alleviate pruritus in NMOSD patients,with no obviousadverser

关 键 词：视神经脊髓炎谱系疾病 瘙痒 A型肉毒毒素 

分 类 号：R744.52[医药卫生—神经病学与精神病学]