免疫球蛋白对重症肌无力危象前状态的疗效

Therapeutic effect of globulin on myasthenic pre-crisis state

目的评价免疫球蛋白治疗重症肌无力危象前状态的临床效果及不良反应。方法回顾性分析2010年1月至2018年12月解放军火箭军特色医学中心住院的重症肌无力(myasthenic gravis,MG)危象前状态的患者43例,给予静脉注射免疫球蛋白(intravenous immunoglobulin,IVIG)0.4 g/(kg·d),连续治疗5 d,在治疗前及治疗第3、6、9、14、21、28天根据临床绝对评分和相对评分判定肌无力严重程度并评价疗效,同时观察药物不良反应。结果IVIG治疗后,86.05%(37/43)的患者避免了肌无力危象(myasthenic crisis,MC)的发生。治疗第3、6、9、14、21、28天的临床绝对评分分别为(20.61±8.81)、(14.58±9.86)、(10.47±7.27)、(11.21±7.14)、(11.28±6.09)、(12.19±6.46),与治疗前临床绝对评分(26.84±6.08)相比明显降低,差异有统计学意义(P<0.05)。治疗第9天与第14、21、28天的临床绝对评分相比,差异无统计学意义(P>0.05)。患者在应用IVIG第3、6、9、14、21、28天有效率分别为62.79%、83.72%和90.70%、88.37%、88.37%、86.05%,疗效不随治疗时间增加而增加。临床及实验室检查未见明显不良反应。结论IVIG治疗MG危象前状态能迅速改善肌无力状态,明显降低MC发生率。IVIG治疗第3天开始起效,第9天治疗效果最好,疗效可持续28 d,且安全性好、不良反应少,值得推荐使用。

Objective To evaluate the clinical effect and adverse reaction of intravenous immunoglobulin(IVIG)in the treatment of myasthenic pre-crisis state.Methods Forty-three patients with myasthenic pre-crisis state who were hospitalized from January 2010 to December 2018 were collected.All the patients were given IVIG 0.4 g/(kg·d)for five consecutive days.Before treatment and after treatment,the severity and therapeutic effect of myasthenia were evaluated by clinical absolute scores and relative scores,and adverse drug reactions were also observed.Results After treatment of IVIG,86.05%(37/43)patients avoided myasthenia crisis.The clinical absolute scores were(20.61±8.81),(14.58±9.86),(10.47±7.27),(11.21±7.14),(11.28±6.09),(12.19±6.46)on the 3 rd,6 th,9 th,14 th,21 st,28 th day after treatment,which were significantly lower than that before treatment[(26.84±6.08),P<0.05].There were no significant differences in clinical absolute scores between the 9 th day and 14 th,21 st,28 th day of the treatment(P>0.05).The effective rates of IVIG at the 3 rd,6 th,9 th,14 th,21 st,28 th day were 62.79%,83.72%,90.70%,88.37%,88.37%and 86.05%,respectively.And the therapeutic effect did not increase with the duration of treatment.No obvious adverse reactions were observed in clinical and laboratory examinations.Conclusions IVIG for the treatment of myasthenic pre-crisis state can rapidly improve muscle weakness and significantly reduce the incidence of myasthenia crisis.IVIG treatment begins to take effect on the 3 rd day,and the curative effect is the best on the 9 th day,which lasts for 28 d.It is safe and has few adverse reactions,which is recommended for treatment of myasthenic pre-crisis state.