复肌宁汤联合免疫抑制剂治疗眼肌型重症肌无力疗效观察及对免疫学指标的影响

Observation of Fujining Tang Combined with Immunosuppressive Agents for Myasthenia gravis of Ocular Type and Its Effect on Immunological Indexes

目的:观察复肌宁汤联合免疫抑制剂治疗眼肌型重症肌无力(MG)的临床疗效及对免疫学指标的影响。方法:将82例眼肌型MG患者随机分为对照组与观察组,每组各41例;对照组给予强的松治疗,观察组给予强的松联合复肌宁汤治疗;观察比较2组治疗前后乙酰胆碱受体抗体前膜受体抗体(AchR QM)和后膜受体抗体(AchR HM)滴度的变化,2组治疗前后免疫因子γ-干扰素(IFN-γ)、白细胞介素-4(IL-4)与白细胞介素-17(IL-17)变化情况,2组临床疗效与并发症情况。结果:总有效率观察组为78.05%,对照组为53.66%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组患者AchR QM、AchR HM滴度均较治疗前降低(P<0.05),且观察组两项指标均明显低于对照组(P<0.05)。治疗后,2组患者IFN-γ、IL-4、IL-17水平均较治疗前降低(P<0.05),且观察组各项指标均明显低于对照组(P<0.05)。并发症发生率观察组为14.63%,对照组为39.02%,2组比较,差异有统计学意义(P<0.05)。结论:复肌宁汤联合强的松治疗眼肌型重症肌无力,可显著减少乙酰胆碱受体抗体滴度,降低免疫反应因子水平,有效改善免疫反应,且并发症少,疗效优于单纯西药治疗。

Objective: To observe the clinical effect of Fujining tang combined with immunosuppressive agents for myasthenia gravis(MG) of ocular type and its effect on immunological indexes. Methods:A total of 82 cases of MG patients of ocular type were randomly divided into the control group and the observation group, 41 cases in each group. The control group was treated with prednisone,and the observation group was additionally treated with Fujining tang. The changes in the titers of the acetylcholine receptor antibody on presynaptic membrane(AchR QM) and on postsynaptic membrane(AchR HM),and the levels of immune factors including interferon-γ(IFN-γ), interleukin-4(IL-4) and interleukin-17(IL-17) before and after treatment in the two groups were observed and compared. The clinical effect and incidence of complications in the two groups were observed and compared. Results:The total effective rate was 78.05% in the observation group and 53.66% in the control group,the difference being significant(P<0.05). After treatment,the titers of AchR QM and AchR HM in the two groups were decreased when compared with those before treatment(P<0.05),and the above two titers in the observation group were significantly lower than those in the control group(P<0.05). After treatment,the levels of IFN-γ,IL-4 and IL-17 in the two groups were decreased when compared with those before treatment(P<0.05), and the above levels in the observation group were significantly lower than those in the control group(P<0.05). The incidence of complications was14.63% in the observation group and 39.02% in the control group,the difference being significant(P<0.05). Conclusion:The therapy of Fujining tang combined with prednisone in treating MG of ocular type can significantly reduce the titer of acetylcholine receptor antibody and the production of immune factors, and effectively improve immune response, with fewer complications,whose curative effect is better than that of simple western medicine.