糖皮质激素冲击治疗后重症肌无力早期一过性加重的机制研究

Mechanism of early transient aggravation after glucocorticoid impact treatment in patients with myasthenia gravis

目的探讨糖皮质激素冲击（GI）治疗后重症肌无力（MG）早期一过性加重的机制。方法选取2012年1月～2013年6月诊治的125例MG患者,并给予GI治疗,统计分析并进行治疗前后临床评分和血清抗胆碱受体抗体滴度（AchR-Ab）、免疫球蛋白IgG和补体C3水平、肌电图检测。结果 GI治疗MG后,7天有效率为57.78%,28天有效率为75.56%,其中肌无力一过性加重发生率为36.0%;肌无力加重后患者临床绝对评分明显高于加重前,差异具有统计学意义（P〈0.05）;桡神经和腋神经低频重复电刺激波幅递减程度明显高于加重前,差异具有统计学意义（P〈0.05）;加重前后患者血清AchR-Ab、IgG和C3水平差异均无统计学意义（P〉0.05）。结论 GI治疗MG后,具有早期一过性加重发生的风险,这可能与激素抑制神经递质的传递有关,但与体内抗体、补体水平变化无关。

Objective To investigate the mechanism of early transient aggravation after glucocorticoid impact（ GI） treatment in patients with myasthenia gravis（ MG）. Methods A total of 125 MG patients who were diagnosed and treated from January 2012 to June2013 were selected and treated with GI. Clinical score,serum anti-acetylcholine receptor antibody（ AChR-Ab） concentration,immunoglobulin Ig G,complement C3,and electromyogram were analyzed before and after treatment. Results On days 7 and 28 of GI treatment,the response rates were 57. 78% and 75. 56%,respectively. The incidence of MG transient aggravation was 36. 0%. After aggravation,patients had a significantly increased clinical absolute score（ P〈0. 05）,and the decreases in the low-frequency repeated electrical stimulation amplitudes of the radial nerve and axillary nerve were also significantly increased（ P〈0. 05）. Serum AChR-Ab,IgG,and C3 levels showed no significant changes after aggravation（ P〉0. 05）. Conclusions MG patients have a risk of early transient aggravation after the treatment of GI,which may be related to the hormone suppression of neurotransmitter transmission,but has nothing to do with the changes in antibody and complement levels.