回顾性分析他克莫司在重症肌无力患者中的应用

Retrospective Study on Treating Myasthenia Gravis Patients with Tacrolimus

目的:回顾性分析他克莫司在重症肌无力(MG)患者中的应用,并与硫唑嘌呤进行对比研究。方法:选择我科于2008年4月至2016年7月收治的使用了他克莫司或硫唑嘌呤治疗的MG患者,收集并比较2组患者的临床资料,包括年龄、性别、病程、神经系统表现、抗体滴度、治疗方案、预后和副作用等。采用美国重症肌无力基金会(MGFA)的干预后状态量表评价治疗效果,以完全稳定缓解(CSR)作为最优结局。结果:共纳入使用了免疫抑制剂并完成随访的MG患者290例,其中使用硫唑嘌呤212例,纳入硫唑嘌呤组,使用他克莫司78例,纳入他克莫司组。比较2组的临床数据结果显示,初治患者选择硫唑嘌呤较多(P=0.023);他克莫司组发病年龄>50岁的患者比例更多(P=0.012),联合使用激素的患者比例更低(P=0.022),达到CSR的时间更短(P=0.018),但2组内最终达到CSR的患者比例没有区别(P=0.113)。结论:相对于硫唑嘌呤,他克莫司的副作用小、起效快,但两者疗效相近。

Objective:To retrospectively investigate the use of tacrolimus in patients with myasthenia gravis(MG)and compare it with that of azathioprine.Methods:Patients with MG who were given tacrolimus or azathioprine in our department between April 2008 and July 2016 were enrolled and evaluated for age,gender,course of disease,neurological status,antibody titer,treatment regimen,prognosis,and side effects.The Myasthenia Gravis Foundation of American(MGFA)post-intervention status was determined to evaluate the curative effect,with complete stable remission(CSR)being the optimal result.Results:A total of 290 MG patients who required immunosuppression were included in this study.Of these,212 were given azathioprine(azathioprine group)and 78 were given tacrolimus(tacrolimus group).Azathioprine was more often used in treating new-onset patients(P=0.023).Compared to the azathioprine group,the tacrolimus group contained a greater proportion of patients over the age of 50(P=0.012)and a smaller proportion of patients simultaneously using hormone treatment(P=0.022);the tacrolimus group achieved CSR in a shorter time(P=0.018)but showed no significant difference in the proportion of patients to reach CSR(P=0.113).Conclusion:Tacrolimus has fewer side effects and faster onset of action than azathioprine,but there was no statistically significant difference in their curative effect.