静滴丙种球蛋白联合大剂量糖皮质激素治疗重症肌无力的疗效分析

Clinical Analysis of Intravenous Gamma Globulin Combined with Highdose Glucocorticoid in the Treatment of Myasthenia Gravis

目的 分析静滴丙种球蛋白联合大剂量糖皮质激素治疗对重症肌无力患者的治疗效果。方法 回顾性分析2013年1月—2021年5月福建省立医院收治的80例重症肌无力患者的临床资料,按照不同用药方法将患者分为单用激素组、联合应用丙球和激素组,各40例。两组患者入院后均进行常规治疗,在此基础上,单用激素组给予甲泼尼龙琥珀酸钠静脉滴注治疗,联合应用丙球和激素组采用大剂量甲泼尼龙联合丙球蛋白静脉滴注治疗。比较两组临床绝对评分、乙酰胆碱受体水平、住院时间、症状缓解时间、不良反应发生率。结果联合应用丙球和激素组治疗后的临床绝对评分(9.1±1.2)分、IgG(8.2±1.3)mg/mL、C3(1.1±0.2)g/L水平均低于单用激素组(13.2±2.4)分、(9.7±0.9)mg/mL、(1.7±0.5)g/L,差异有统计学意义(t=9.664、6.000、7.047,P<0.05);联合应用丙球和激素组治疗后的乙酰胆碱受体水平下降并优于单用激素组,差异有统计学意义(P<0.05);联合应用丙球和激素组住院时间(18.4±2.7)d、症状缓解时间(7.4±1.8)d均短于单用激素组(33.7±3.7)、(12.4±2.5)d,差异有统计学意义(t=21.126,10.265,P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论 重症肌无力患者采用甲泼尼龙联合丙种球蛋白静脉滴注治疗能有效抑制自身免疫反应,改善肌无力症状。

Objective To observe the therapeutic effect of intravenous gamma globulin combined with high-dose glucocorticoid on patients with myasthenia gravis. Methods The clinical data of 80 patients with myasthenia gravis treated in Fujian Medical Hospital from January 2013 to may 2021 were analyzed retrospectively. According to different medication methods, the patients were divided into hormone alone group, combined with gamma globulin and hormone group, with 40 cases in each group. Both groups of patients were treated with routine treatment after admission.On this basis, the hormone alone group was treated with methylprednisolone sodium succinate intravenous drip, and the combined with gamma globulin and hormone group was treated with high-dose methylprednisolone combined with gamma globulin intravenous drip. The, the clinical absolute scores, acetylcholine receptor levels, time of stay, symptom remission time, and incidence of adverse reactions were compared of the two groups. Results After treatment, the clinical absolute score(9.1±1.2) points, IgG(8.2±1.3) mg/mL, and C3(1.1±0.2) g/L levels in the combined with gamma globulin and hormone group were significantly lower than those in the hormone alone group(13.2±2.4) points,(9.7±0.9) mg/mL,and(1.7±0.5) g/L, and the difference was statistically significant(t=9.664, 6.000, 7.047, P<0.05). After treatment, the level of acetylcholine receptor in the combined with gamma globulin and hormone group decreased and was better than that in the hormone alone group, the difference was statistically significant(P<0.05). The hospitalization time(18.4±2.7) d and symptom relief time(7.4±1.8) d in the combined with gamma globulin and hormone group were shorter than those in the hormone alone group(33.7±3.7) d and(12.4±2.5) d, and the difference was statistically significant(t=21.126, 10.265, P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion methylprednisolone combined with intravenous igamma globulin can effectively inhibit autoimmune response and improve the symptoms of myasthenia gravis.