他克莫司治疗全身型MG疗效和安全性分析

Analysis of the efficacy and safety of tacrolimus in the treatment of systemic myasthenia gravis

目的探析他克莫司治疗全身型重症肌无力(MG)效和安全性。方法分析成都医学院第一附属医院神经内科2013年9月至2019年6月收治的69例全身型MG患者资料,按照治疗方案差异分组,观察组53例,采用他克莫司治疗,并细分亚组,A组28例(他克莫司剂量2mg·d^(-1)),B组25例(他克莫司剂量3mg·d^(-1)),收取同期采用常规方案治疗的16例纳入对照组,均持续治疗12w,比较各组短期疗效,治疗前、治疗4、8、12w评估MG定量评分(QMGS)、日常生活能力评分表(ADL),记录不良反应。结果亚组和对照组治疗4、8、12w的QMGS评分与ADL评分均呈不断降低趋势,且观察(A、B)组治疗8、12w的QMGS评分与ADL评分与对照组比较差异有统计学意义(P<0.05)。观察B组治疗4、8、12w的QMGS评分与ADL评分减少幅度略优于观察A组,但比较差异无统计学意义(P>0.05)。观察组A组治疗有效率为82.14%,观察B组治疗有效率为88.00%,对照组治疗有效率为62.50%,观察(A、B)组短期疗效显著高于对照组(P<0.05),观察A组与B组疗效比较差异无统计学意义(P>0.05)。各组患者均未发生严重不良反应,经对症干预后不良反应缓解,未发生因药物反应严重而停止用药情况,各组不良反应比较差异无统计学意义(P>0.05)。结论他克莫司(2~3mg·d^(-1))治疗全身型MG短期疗效较佳,可降低QMGS、ADL评分,减少肌无力危象及再住院风险。

Objective To investigate the efficacy and safety of tacrolimus in the treatment of systemic myasthenia gravis(MG).Methods To analyze the data of 69 patients with systemic MG admitted to the Department of Neurology of the First Affiliated Hospital of Chengdu Medical College from September 2013 to June 2019,according to the difference of treatment plan,53 patients in the observation group were treated with tacrolimus and subdivided into subgroup(group A,n=28)(tacrolimus dose 2 mg·d^(-1)),B group,(n=25,3 mg·d^(-1)),16 patients who were treated with the conventional regimen during the same period were collected into the control group,and they were treated continuously for 12 w.The short-term efficacy of each group was compared.before treatment,the patients were treated for 4 and 8 weeks,and the activity of daily living(ADL),the quantitative myasthenia gravis score(QMGS),was evaluated at 12 weeks.Results the subgroup and control group QMGS score and ADL score decreased continuously at the 12 th week after treatment for 4,8 and 12 weeks,and the QMGS score and ADL score for 12 weeks were significantly different from those in the control group(P<0.05).The decrease of QMGS score and ADL score in group B was slightly better than that in group A at the 12 th week,but there was no significant difference between the two groups(P>0.05).The effective rate of observation group A was 82.14%,the effective rate of observation group B was 88.00%,and that of control group was 62.50%.The short-term curative effect of observation group B was significantly higher than that of control group(P<0.05).There was no significant difference between group A and group B(P>0.05).No serious adverse reactions occurred in all groups.After symptomatic intervention,the adverse reactions were alleviated and no drug use stopped due to serious drug reactions.There was no significant difference in the adverse reactions in each group(P>0.05).Conclusion tacrolimus(2-3 mg·d^(-1))is effective in the treatment of systemic MG,which can reduce QMGS,ADL score,reduce the risk of muscle weakness crisis and readmission,and improve the quality of life.