沙丁胺醇治疗重症肌无力的临床观察

The therapeutic effect of salbutamol on myasthenia gravis

目的评价硫酸沙丁胺醇(salbutamol sulfate)治疗重症肌无力(myasthenia gravis,MG)的临床疗效。方法选取胸腺切除术后的MG住院患者51例,按手术先后顺序分为沙丁胺醇组(SS组,n=27)和非沙丁胺醇组(非SS组,n=24),SS组患者给予免疫抑制剂和沙丁胺醇治疗,非SS组仅给予免疫抑制剂治疗。采用临床绝对评分法和相对评分法对患者的临床疗效进行评定,并对部分患者治疗2年后的疗效进行随访。结果 SS组和非SS组患者治疗前与治疗2个月后的临床绝对评分差值及降幅间比较无统计学差异(均P>0.05),两组间治疗总有效率比较差异无统计学意义(P>0.05),SS组的平均住院天数、呼吸机使用比例显著低于非SS组(均P<0.05)。对51例患者中的36例随访2年,SS组(19例)减药率及停药率明显高于非SS组(17例)(均P<0.05),而复发率、感染率均明显低于非SS组(均P<0.05)。两组不良反应发生率间比较无统计学差异。结论在免疫抑制剂基础上联用沙丁胺醇有助于早期尽快改善MG患者肌无力症状,降低因免疫抑制剂减药或停药时引发的感染率,有效预防症状反弹,减少病情复发,且无明显不良反应。

Objective To evaluate the efficacy of salbutamol sulfate on myasthenia gravis （MG）. Methods Fifty-one MG patients, who received extended thymectomy, were randomly assigned to 2 groups： the salbutamol sulfate group （SS group, n=27） and the nonsalbutamol sulfate group （non-SS group, n=24）. The SS group were treated with immunosuppressants and salbutamol sulfate, and the non-SS group were treated only with immunosuppressants. The efficacy was evaluated by absolute and relative clinical scores. The patients were followed for more than 2 years and their prognoses were evaluated. Results There were no statistically significant differences in clinical absolute score and total effectiveness rate between these two groups （both P〉 0.05）. The rate of respiratory support, as well as in-hospital duration, in the SS group was significantly less than that in the non-SS group （both P〈0.05）. 36 patients finished the two years＇ following-up study, and both of score decrement and withdrawal rates in the SS group were significantly higher than those in non-SS group （both P〈0.05）. The relapse rate of the SS group was significantly lower than that of the non-SS group, the same happened regarding the infection rate （both P 〈 0.05）. The difference of side effects between the two groups was statistically insignificant. Conclusions Combining immunosuppressant treatment with salbutamol sulfate might improve the clinical symptoms of MG patients quickly, and might be helpful in reducing infection rate and relapse rate when immunosuppressant was decreased or withdrawn. No side effect developed during the follow up.