两种激素冲击方案治疗成人全身型MG的临床疗效观察

Clinical effects of two hormonal shock therapies in treatment of adult systemic MG

目的观察两种激素冲击方案治疗成人全身型重症肌无力(MG)的临床疗效。方法选择成人全身型MG患者86例,随机分为A组与B组,各43例,分别采用中等剂量地塞米松加小剂量强的松冲击治疗、甲强龙加小剂量强的松冲击治疗,均维持治疗3个月。比较两组治疗1、3个月的总有效率,采用MG定量评分(QMGS)评估两组肌无力严重程度,测定两组治疗前后血清乙酰胆碱受体自身抗体(AchRAb)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平,并观察不良反应。结果治疗1、3个月时,两组总有效率比较无显著差异(P> 0.05);治疗后1、2、3个月,两组QMGS评分及血清AchRAb、TNF-α、IL-6水平均降低(P <0.05),但组间无显著差异(P> 0.05);A组治疗3个月内不良反应发生率低于B组(P <0.05)。结论中等剂量地塞米松或中等剂量甲强龙冲击治疗方案治疗成人全身型MG疗效相近,均可明显改善患者病情,降低炎症反应水平,但地塞米松冲击治疗方案的不良反应相对较轻,值得在临床推广应用。

Objective To observe the clinical effects of two hormonal shock therapies in treatment of adult systemic myasthenia gravis(MG). Methods A total of 86 patients with systemic MG were selected and randomly divided into group A and group B(n=43,respectively). Group A was treated with moderate dose of dexamethasone and small dose of prednisone shock and group B with methylprednisolone and small dose of prednisone shock for three months. The overall response rate(ORR) after one and three months of treatment was compared between the two groups. MG quantitative scoring(QMGS) was used to evaluate the severity of myasthenia.The levels of serum acetylcholine receptor autoantibody(AchRAb), tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) before and after the treatment in the two groups were determined. The adverse reactions were observed. Results One and three months after the treatment, there was no significant difference in the ORR between the two groups(P > 0.05); one, two and three months after the treatment, the QMGS scores and the levels of serum AchRAb, TNF-α and IL-6 decreased(P < 0.05), but there was no significant different between the two groups; the incidence of adverse reactions within three months of treatment in group A was lower than that in the group B(P < 0.05). Conclusion Moderate dose of dexamethasone and Moderate dose of methylprednisolone shock therapies have equivalent effects in the treatment of adult systemic MG and can obviously improve patients’ condition, lower the levels of inflammatory response. However, dexamethasone shock therapy has fewer adverse reactions and is worthy of clinical popularization and application.