肾上腺糖皮质激素不同疗法治疗重症肌无力的对照研究

Control study on different usage of glucocorticoid in treatment of myasthenia gravis

目的观察肾上腺糖皮质激素(GC)不同治疗方案治疗成人全身型重症肌无力(MG)的临床疗效及不良反应。方法将65例MG患者随机分为2组,递增疗法组33例给予小剂量泼尼松递增治疗,冲击疗法组32例给予大剂量甲基泼尼松龙(MPL)治疗;观察各组治疗前及治疗后1,3个月绝对评分与相对评分的变化,比较2组治疗后评分及不良反应发生情况。结果大剂量MPL冲击疗法及泼尼松小剂量递增疗法均能显著改善MG的症状,患者临床绝对评分相应降低(P<0.01);且随治疗时间的延长(3个月),疗效呈持续性(P<0.01)。在第1个月末冲击疗法组临床绝对评分改善更显著(P<0.05)。治疗1个月内冲击疗法组血糖增高率低于递增疗法组(P<0.05)。2组不良反应大致相同。结论大剂量GC冲击疗法可以更快速地改善MG的症状。

Objective It is to observe the clinical effect and adverse reactions of the different usage of glucocorticoid（GC） in the treatment of adults systemic type of myasthenia gravis（MG）.Methods Sixty-five patients with MG were randomly divided into 2 groups,which is small-dose prednisone therapy group（33 cases） and high-dose methylprednisolone（MPL） therapy group（32 cases）.Absolute scores were compared in the same group before treatment and after treatment（1,3 months）,absolute scores and relative scores were compared between two groups before treatment and after treatment,and incidence of adverse reactions were compared between two groups after treatment（1,3 months）.Results Both of small-dose prednisone therapy and high-dose MPL therapy could significantly reduced the symptoms of patients with MG,clinical absolute scores of these were reduced correspondingly（P0.01）,and efficacy was sustained（P0.01）.The clinical efficacy of high-dose MPL therapy group was more significant than small-dose therapy group at the end of the first month,and the reducing of its absolute scores were more significant（P0.05）.The adverse reactions between two groups were similar.The incidence of glucose increasing was lower in high-dose MPL therapy group than in small-dose prednisone therapy group at the end of the first month（P0.05）.Conclusion The high-dose MPL can improve the symptom of MG more quickly than small-dose prednisone.