甲泼尼龙治疗急性脊髓炎短期预后转归与剂量的量效关系

Relationship between dose and effect of methylprednisolone in the treatment of acute myelitis on short term prognosis

目的观察不同剂量甲泼尼龙对急性脊髓炎短期预后的影响。方法前瞻性选择88例急性脊髓炎患者,按随机数字表法分为观察大剂量组与小剂量组,各44例。两组均接受常规基础治疗,在此基础上,大剂量组:静脉滴注甲泼尼龙,1 g/d,连续5 d;小剂量组:静脉滴注,0.5 g/d,连续5 d。然后两组继续口服甲泼尼龙4周,60 mg/d。比较两组治疗总有效率、治疗前后的上肢与下肢波幅与潜伏期、排尿排便恢复时间、肌力改善至2级所用时间、下地行走时间及不良反应总发生率。结果大剂量组治疗总有效率93.18%,显著高于小剂量组的77.27%(P<0.05)。两组治疗后的上肢与下肢的波幅均显著升高、潜伏期均减小(P<0.05);大剂量组治疗后上肢与下肢的波幅显著高于小剂量组、上肢与下肢潜伏期显著低于小剂量组(P<0.05)。大剂量组排尿排便恢复时间、肌力改善至2级所用时间、下地行走时间分别为(10.01±2.02)d、(12.19±2.32)d、(13.65±2.84)d,均显著短于小剂量组(12.99±2.49)d、(14.48±2.51)d、(15.47±3.01)d(P<0.05)。大剂量组与小剂量组不良反应总发生率分别为18.18%和13.64%,差异无统计学意义(P>0.05)。结论大剂量甲泼尼龙冲击治疗急性脊髓炎可改善急性脊髓炎患者锥体束传导功能、促进神经功能恢复,且安全可靠,是急性脊髓炎的理想治疗方案之一。

Objective To observe the effect of different doses of methylprednisolone on short-term prognosis of acute myelitis. Methods A total of 88 patients with acute myelitis were selected and randomly divided into high dose group and low dose group according to random number table with 44 cases in each group. Both groups received routine basic treatment. On this basis,high-dose group： intravenous drip,1 g/d,continuous for 5 d; low-dose group： intravenous drip,0. 5 g/d,continuous for 5 d. Then the two groups continued oral administration for 4 weeks,60 mg/d. The total effective rate,the amplitude and latency of upper limbs and lower limbs before and after treatment,the urination and defecation recovery time,time of muscle strength improved to spent 2,walking time under the ground and the total incidence of adverse reactions were compared between the two groups. Results The total effective rate of high-dose group was 93. 18%,which was significantly higher than that of 77. 27% in low-dose group（ P〈0. 05）. The amplitude of upper limbs and lower limbs of both groups were significantly increased（ P〈0. 05）,and the latency of upper limbs and lower limbs were both decreased（ P〈0. 05）. The amplitude of upper limbs and lower limbs in high dose group were significantly higher than those of low dose group,and the latency of upper limbs and lower limbs were significantly lower than those of low-dose group（ P〈0. 05）. The urination and defecation recovery time,time of muscle strength improved to spent 2,walking time under the ground of the high-dose group were（ 10. 01 ± 2. 02） d,（ 12. 19 ± 2. 32） d and（ 13. 65 ± 2. 84） d,which were significantly shorter than those of（ 12. 99 ± 2. 49） d,（ 14. 48 ± 2. 51） d and（ 15. 47 ± 3. 01） d in low-dose group（ P〈0. 05）. The total incidence of adverse reactions in high-dose group and low-dose group were 18. 18% and 13. 64%,respectively,with no significant difference（ P〈0. 05）. Conclusion The high dose methylprednisolone treatment of acute myelitis can improve pyramidal tract conduction and promote neurological function recovery in patients with acute myelitis,and it is safe and reliable. It is one of the ideal treatment for acute myelitis.