中药联合胆碱酯酶抑制剂治疗重症肌无力患者呼吸肌力的变化

The changes of respiratory muscle strength by traditional Chinese medicine combined with cholinesterase inhibitors in myasthenia gravis patients

目的探讨重症肌无力（MG）患者呼吸肌力在中药联合胆碱酯酶抑制剂治疗后的变化。方法对胆碱酯酶抑制剂耐药的MG患者34例，其中Ⅰ型MG14例，Ⅱ型MG20例。均经溴化吡啶斯的明360～480mg／d治疗3个月～3年无效复诊，除维持原有治疗外再联合中药饮剂治疗，待临床症状改善时，对溴化吡啶斯的明逐渐减量，继续中药治疗4～6个月。观察治疗前后肺功能：肺活量（VC）、最大自主通气量（MVV）、最大吸气压（PIM）、最大呼气压（PEM）、呼吸中枢驱动压（P0.1）、残气量（RV），分别取实测值占预计值百分比（P0.1 除外），并进行临床严重程度评分。结果34例MG患者经胆碱酯酶抑制剂单独治疗一段时间后，VC、MVV、PIM、PEM、RV等占预计值百分比无明显改善（P均〉0．05）；联合中药治疗后，MG患者VC、MVV、PIM、PEM占预计值的百分比分别由治疗前的（76．66±18．59）％、（68．03±10．45）％、（43．25±18．16）％、（21．75±14．44）％增加到（86．91±14．87）％、（75．11±11．17）％、（52．66±20．32）％、（28．56±10．06）％，RV由治疗前的（164．94±67．97）％降到（143．16±79．21）％（t值分别为3．41、3．03、3．56、2．36、4．71，P均〈0．05）；与Ⅱ型MG患者相比，Ⅰ型MG患者PIM[（65．80±28．03）％、（52．66±20．32）％]、PEM[（37．03±20．57）％、（28．56±19．06）％]改善显著（t值分别为3．85、3．16，P均〈0．01），另外Ⅱ型MG患者呼吸肌耐力[（108．71±17．56）％]较Ⅰ型MG组[（96．01±14．12）％]改善更加显著（t=3．92，P〈0．05）。结论中药联合胆碱酯酶抑制剂能有效地改善对胆碱酯酶抑制剂耐药患者的肺功能和呼吸肌力，与Ⅱ型MG患者相比，Ⅰ型患者肺功能的呼吸肌肌力改善更加明显，但Ⅱ型MG患者呼吸肌耐力的改善优于Ⅰ型MG患者。

Objective To observe the changes of respiratory muscle strength by traditional Chinese medicine combined with cholinesterase inhibitors in myasthenia gravis （MG） patients. Methods Thirty-four cholinesterase inhibitor-resistant patients, of them 14 were MG patients with stage Ⅰ , and 20 were stage Ⅱ , were treated with bromide dimethylcarbamate （ 360 - 480 mg/d）. Traditional Chinese potion were administered in those without effectiveness, and the dosages of bromide dimethylcarbamate decreased with Traditional Chinese potion lasting for 4 - 6 months. Vital capacity （ VC ）, maximal voluntary ventilation （ MVV ）, maximal inspiratory pressure （ PIM）, maximal expiratory pressure （ PEM ） , respiratory centre driving pressure （ P0.1 ） , residual volume （ RV ） were measured before and after treatment. Results The amelioration of VC, MVV, PIM, PEM, P0.1, RV, respiratory muscle strength and other indicators of 34 MG patients were not obviously after treatment with cholinesterase inhibitor alone （P 〉 0. 05 ）. After treatment with traditional Chinese medicine combined with cholinesterase inhibitors, VC, MVV,PIM, PEM （ before treatment： 76. 66% ± 18. 59%, 68.03% ± 10.45%, 43.25% ± 18.16%, 21.75% ±14.44% ） increased significantly in all 34 MG patients （after treatment：86. 91% ± 14. 87% ,75.11% ± 11.17%, 52.66% ±20.32% ,28.56% ± 10.06%） （P〈0.05）. RV decreased from 164.94% ±67.97% to 143.16%± 79. 21% （P 〈 0. 01 ）, and respiratory muscle strength, endurance and other indicators significantly improved （P 〈 0. 01 ）. PIM（65.80% ± 28.03% to 52. 66% ± 20. 32% ）, and PEM （37.03%± 20. 57% to 28.56% ± 10. 06% ） improved more significantly in group stage than in group stage （ P 〈 0. 01 ）. Respiratory muscle endurance in stage Ⅰ patients （ 108. 71%±17.56% ） improved significantly than stage Ⅱ patients （96. 01% ± 14. 12%, P 〈 0. 01）. Conclusions Traditional Chinese medicine combined with cholinesterase inhibitors could effectively improve the lung function and respiratory muscle strength in patients with resistance of the cholinesterase inhibitors. The improvement of lung function, respiratory muscle strength were more obviously in stage Ⅰ patients than in stage Ⅱ patients. Respiratory muscle strength and endurance were improved greater in stage Ⅱ than in stage Ⅰ patients.