大剂量免疫球蛋白治疗多发性硬化急性期的疗效观察

Effect of High Dose of Intravenous Immunoglobulin in the Treatment of Patients with Multiple Sclerosis in Acute Phase

目的比较大剂量丙种球蛋白和甲基泼尼松龙静脉治疗多发性硬化(MS)患者急性期的临床疗效。方法将临床确诊的40例复发-缓解型MS(relapsing-remitting multiple sclerosis,RRMS)急性期患者随机分为丙种球蛋白治疗组(n=20)和甲基泼尼松龙治疗组(n=20),观察两组治疗前后EDSS评分、平均住院时间及复发情况。结果丙种球蛋白治疗组治疗第7天的残疾状态扩展评分(extended disability status scale,EDSS)评分、平均住院天数、复发率分别为(3.1±1.1)分、(20.1±9.6)d、10.0%,均明显优于甲基泼尼松龙治疗组[分别为(4.4±1.9)分、(31.6±17.2)d、30%](均P<0.05)。结论急性期MS患者静脉点滴大剂量免疫球蛋白和甲基泼尼松龙均可明显改善临床症状,减少住院时间,降低复发率。其中丙种球蛋白的疗效更明显,可作为急性发作期MS患者的首选免疫治疗方法。

Objective To compare the therapeutic efficacy of high dose of intravenous gamma globulin with that of methylprednisolone in the treatment of multiple sclerosis in acute phase. Methods Forty cases with relapsing-remitting multiple sclerosis （RRMS） in acute phase were randomized to be grouped into intravenous immunoglobulin（IVIG） （n=20） and methylprednisolone （n=20） therapy. The extended disability status scale （EDSS） grades, mean time of being in hospital, recurrent cases in the follow up were observed in the two groups. Results In IVIG group, the EDSS grade at the 7th day was 3.1±1.1, mean time of being in hospital was 20.1±9.6 days and there were 2 recurrent cases after treatments. All of which were significantly better than the same data in methylprednisolone group. Conclusions In the treatment of RRMS patients in acute phase, high dose immunoglobulin and methylprednisolone both improving the clinical symptom, reducing the mean time of being in hospital, and decreasing the recurrent rate. The gamma globulin should be used as the first consideration of immunological treatments for MS patients in acute phase, since it possesses better effect therapeutically than methylprednisolone.