血浆置换联合大剂量激素冲击疗法对重症肌无力患者疗效及安全性

Efficacy and safety of plasma exchange combined with high-dose hormone shock therapy in patients with myasthenia gravis

目的探究血浆置换联合大剂量激素冲击治疗重症肌无力(MG)的有效性及安全性。方法前瞻性选取2017年3月到2019年12月海南医学院第一附属医院收治的75例MG患者,按照随机数字表法分为观察组(n=38)和对照组(n=37)。对照组采用大剂量激素冲击治疗,观察组采用血浆置换联合大剂量激素冲击治疗。比较两组治疗后临床评分、起效时间、住院时间、气切率、免疫球蛋白水平和不良反应发生情况。结果治疗后两组患者临床绝对评分均下降,且观察组低于对照组(3.42±0.68分vs.8.04±1.17分),差异具有统计学意义(P<0.05);观察组患者起效时间、住院时间、气切率低于对照组(7.04±0.96 d vs.10.35±1.18 d、11.21±1.52 d vs.16.25±2.40 d、0.00%vs.18.92%),差异具有统计学意义(P<0.05);治疗后观察组患者外周静脉血中IgA、IgG、IgM水平均低于对照组(1.96±0.38 g/L vs.2.14±0.27 g/L、8.80±1.05 g/L vs.9.24±1.27 g/L、0.92±0.13 g/L vs.1.08±0.14 g/L),差异具有统计学意义(P<0.05);两组患者消化道症状、肌肉痉挛、库欣反应、低血压等不良反应发生率(2.63%vs.5.41%、7.89%vs.5.41、2.63%vs.2.70%、5.26%vs.2.70%)无显著差异(P>0.05)。结论血浆置换联合大剂量激素冲击能有效改善重症肌无力患者临床症状,抑制其免疫反应强度,是一种较为安全有效的治疗方法。

Objective To investigate the efficacy and safety of plasma exchange(PE)combined with high-dose hormone shock in the treatment of myasthenia gravis(MG).Methods A total of 75 patients with MG treated in the First Affiliated Hospital of Hainan Medical College from March 2017 to December 2019 were divided into observation group(n=38)and control group(n=37)according to the random number table method.The control group was treated with high-dose hormone shock,and the observation group was treated with PE combined with high-dose hormonal shock therapy.The clinical scores,onset time,length of stay,gas-cut rate,immunoglobulin level,and adverse reactions were compared between the two groups after treatment.Results After treatment,the absolute clinical scores of the two groups decreased,and the observation group was lower than the control group(3.42±0.68 points vs.8.04±1.17 points,P<0.05).The onset time,length of stay,and gas-cut rate of the observation group were lower than those of the control group(7.04±0.96 d vs.10.35±1.18 d,11.21±1.52 d vs.16.25±2.40 d,0.00%vs.18.92%,P<0.05).The levels of IgA,IgG,and IgM in peripheral venous blood in the observation group were lower than those in the control group after treatment(1.96±0.38 g/L vs.2.14±0.27 g/L、8.80±1.05 g/L vs.9.24±1.27 g/L、0.92±0.13 g/L vs.1.08±0.14 g/L,P<0.05).There was no significant difference in the incidence of adverse reactions such as the gastrointestinal symptoms,muscle spasm,Cushing response and low blood pressure in the two groups(2.63%vs.5.41%,7.89%vs.5.41,2.63%vs.2.70%,5.26%vs.2.70%,P>0.05).Conclusion Plasma exchange combined with high-dose hormonal shock can effectively improve the clinical symptoms in patients with myasthenia gravis and suppress the intensity of their immune response,which is a safe and effective treatment method.