肉毒毒素临床作用的影响因素及对策

Influential factors of the clinical function of botulinus toxin and the countermeasures

目的:从国内外肉毒毒素对上运动神经元损伤后肢体痉挛的治疗及相关研究出发,探讨影响肉毒毒素临床作用的因素及对策。资料来源:应用计算机检索Medline1998-01/2005-05与上运动神经元损伤后肉毒毒素治疗肢体痉挛相关的文献,检索词“botulinumtoxin,spasticity/spastic”,并限定文献语种为英文。同时计算机检索万方数据库2003-01/2005-05与上运动神经元损伤后肉毒毒素治疗肢体痉挛相关的文献,检索词“肉毒毒素,痉挛”,并限定文献语种为中文。资料选择:从资料中选取包括治疗组和对照组的文献,然后选择随机临床试验的研究。纳入标准:①上运动神经元损伤后肉毒毒素治疗肢体肌肉痉挛的随机对照临床试验。②临床试验研究包括平行对照组。③治疗组采用了含肉毒毒素的治疗。排除标准:非上运动神经元损伤后的肌张力异常,综述类文献,没有对照组的文献。资料提炼:共收集98篇关于上运动神经元损伤后肉毒毒素治疗肢体肌肉痉挛的临床试验。49个试验纳入标准。排除的49篇中6篇是综述,43篇为无对照组。资料综合:49个试验包括2679例患者,分别对肉毒毒素治疗上运动神经元损伤后肢体痉挛进行评价。在治疗过程中明确功能目标,采用个体化剂量,应用电刺激准确定位,确保A型肉毒毒素最大限度地与神经肌肉接头处的作用位点相结合,发挥其最大的生物学效应。而注射后采用电刺激、牵张等相应的康复治疗可以增强治疗效果。结论:肉毒毒素对上运动神经元损伤后肢体肌肉痉挛的疗效是肯定的,但其应用方法需要进一步研究和规范。

OBJECTIVE： On the basis of the study of botulinum toxin type A （BTXA） on the treatment of muscle spasticity after upper motor neuron syndrome patients, and explore the influential factors of the clinical function of botulinus toxin and the countermeasures DATA SOURCES： A computer-based online search of Medline database was undertaken to identify articles about BTX-A in the treatment of muscle spasticity after upper motor neuron syndrome published in English from January 1998 to May 2005 by using the keywords of ＂botulinum toxin, spasticity/spastic＂. Meanwhile, Chinese articles about BTX-A in the treatment of muscle spasticity after upper motor neuron syndrome published between January 2003 and May 2005 were searched in Wanfang database, the keywords were ＂botulinum toxin, spasticity/spastic＂in Chinese. STUDY SELECTION： The literatures of randomized controlled trials containing study group and control group were selected. Inclusive criteria： （1） randomized controlled trials about BTX-A in the treatment of music spasticity after upper motor neuron syndrome; （2）clinical trial containing parallel control group; （3） the subjects in the study group were treated with local intramuscular injections of BTX-A. Reviews and literatures without control group or not for upper motor neuron syndrome were excluded. DATA EXTRACTION： Ninety-eight randomized controlled trials about BTX-A in the treatment of muscle spasticity after upper motor neuron syndrome were collected, and 49 trials met the inclusive criteria. The excluded 49 trials included 6 papers of overview and 43 papers without control group. DATA SYNTHESIS： Forty-night trials including 2 679 patients, respectively analyzed the data of upper motor neuron syndrome after BTX-A treatment. During the treatments, the functional goal was clear, individualized dosage was used, apposition was made accurate by electric simulation to ensure BTX-A could combine with action site at the myoneural junction maximally, and play its maximal biological effect. However, electric simulation, stretch and other rehabilitative treatment after injection can enhance the therapeutic effect. CONCLUSION： The injection of BTX-A is effective for limb spasticity after upper motor neuron syndromes, but the system of treatment still needs further improvement and specification.