静脉注射免疫球蛋白与血浆置换治疗重症肌无力疗效及对患者T淋巴细胞亚群的影响

The efficacy of intravenous immunoglobulin and plasma exchange in the treatment of myasthenia gravis and its influence on T lymphocyte subsets in patients

目的分析静脉注射免疫球蛋白(IVIG)与血浆置换(PLEX)治疗重症肌无力(MG)疗效及对患者T淋巴细胞亚群的影响。方法80例MG患者,按随机数字表法分为PLEX组与IVIG组各40例,PLEX组予PLEX治疗,IVIG组予IVIG治疗,比较两组治疗有效性、AchRAb水平、T淋巴细胞亚群、重症肌无力症状与生活质量及不良反应。结果治疗后,IVIG组治疗有效性优于PLEX组(P<0.05);两组AchRAb水平较治疗前降低,且IVIG组下降幅度大于PLEX组(P<0.05);两组CD3^+、CD4^+、CD4^+/CD8^+较治疗前升高,CD8^+、CD4^+CD25^+较治疗前降低,IVIG组变化幅度大于PLEX组(P<005);两组ARS-MG、MG-ADL评分较治疗前降低(P<0.05);IVIG组不良反应发生率低于PLEX组(P<0.05)。结论IVIG治疗MG疗效优于PLEX,可显著提高治疗有效性,降低AchRAb水平,调节T淋巴细胞亚群平衡,增强患者免疫功能,缓解重症肌无力症状,提高生活质量。

Objective To analyze the efficacy of intravenous immunoglobulin(IVIG)and plasma exchange(PLEX)in the treatment of myasthenia gravis(MG)and its influence on T lymphocyte subsets.Methods Eighty patients with MG were randomly di vided into PLEX and IVIG groups,40 in each group.The PLEX group was treated with PLEX,and the IVIG group was treated with IVIG.The treatment effectiveness,AchRAb level,T lymphocyte subsets,myasthenia gravis symptoms,quality of life and adverse reactions were compared between the two groups.Results After treatment,the treatment effectiveness in the IVIG group was significantly better than that in the PLEX group.The AchRAb level in the two groups was significantly decreased compared with that before treatment(P<0.05),and the decrease in the IVIG group was larger than that in the PLEX group(P<0.05).The CD3+,CD4+and CD4+/CD8+in the two groups were significantly increased compared with those before treatment(P<0.05)while the CD8+and CD4+CD25+were significantly decreased(P<0.05),and the changes in the IVIG group were larger than those in the PLEX group(P<0.05).The scores of ARS MG and MG ADL in the two groups were significantly decreased compared with those before treatment(P<0.05),and there were statistically significant differences between the two groups(P<0.05).The incidence rate of adverse reactions in the IVIG group was significantly lower than that in the PLEX group.Conclusion IVIG has better efficacy than PLEX in the treatment of MG.It can significantly improve the treatment effectiveness,reduce the AchRAb level,regulate the balance of T lymphocyte subsets,enhance the immune function,relieve the symptoms of myasthenia gravis and improve the quality of life.