他克莫司治疗慢性炎性脱髓鞘性多发性神经根神经病患者的临床效果

Clinical efficacy of tacrolimus in the treatment of patients with chronic inflammatory demyelinating polyradiculoneuropathy

目的 探讨他克莫司对慢性炎性脱髓鞘性多发性神经根神经病(CIDP)患者病情程度、日常生活能力及临床结局的影响。方法 采用随机数表法将2018年1月至2021年8月鄂尔多斯市中心医院收治的40例CIDP患者分为对照组和研究组,每组各20例。对照组采用一线诱导治疗联合泼尼松治疗,研究组采用一线诱导治疗联合他克莫司治疗,比较两组临床症状缓解时间、肢体运动功能、神经功能、日常生活能力、病情程度、不良反应情况、肝肾功能指标及临床结局。结果 两组感觉障碍、四肢乏力、四肢疼痛、腱反射异常缓解时间比较,差异无统计学意义(P> 0.05);治疗后两组英国医学研究委员会(MRC)肌力测评表分级、Barthel指数(BI)评定量表评分均高于治疗前,美国脊柱损伤协会(ASIA)神经功能评分低于治疗前,差异有统计学意义(P <0.05),两组治疗后MRC肌力测评表分级、BI评定量表评分、ASIA神经功能评分比较,差异无统计学意义(P> 0.05);两组病情改善程度比较,差异无统计学意义(P> 0.05);两组不良反应总发生率、肝肾功能指标、复发率、病死率比较,差异无统计学意义(P> 0.05)。结论 他克莫司临床疗效与泼尼松相当,能够在较短的时间内缓解患者临床症状,改善其肢体运动功能、神经功能及日常生活能力,且安全性较高。

Objective To explore the effect of tacrolimus on the severity of illness,activity of daily living,and clinical outcomes of patients with chronic inflammatory demyelinating polyradiculoneuropathy(CIDP).Methods A random number table method was used to divide 40 patients with CIDP admitted to Ordos Central Hospital in Inner Mongolia from January 2018 to August 2021 into the control group and the study group,with 20 cases in each group.The control group received first-line induction therapy combined with prednisone treatment,while the study group received first-line induction therapy combined with tacrolimus treatment.The clinical symptom relief time,limb motor function,neurological function,activity of daily living,severity of illness,adverse reactions,liver and kidney function indicators,and clinical outcomes of the two groups were compared.Results The relief time of sensory disorders,limb weakness,limb pain,and abnormal tendon reflex between the two group was compared,without statistically significant difference(P>0.05).After the treatment,the scores of the Medical Research Council(MRC)muscle strength assessment grading scale and Barthel index(BI)assessment scale in both groups were higher than those before the treatment,while the American Spinal Injury Association(ASIA)neurological function score was lower than that before the treatment,with statistically significant difference(P<0.05).The MRC muscle strength assessment scale grading,BI assessment scale,and ASIA neurological function score after the treatment were compared between the two groups,without statistically significant differences(P>0.05).The degree of improvement of illness was compared between the two groups,without statistically significant difference(P>0.05).The incidence of adverse reactions,liver and kidney function indicators,recurrence rate,and mortality rate were compared between the two groups,without statistically significant differences(P>0.05).Conclusion The clinical efficacy of tacrolimus is comparable to that of prednisone,and it can alleviate clinical symptoms,and improve limb motor function,neurological function,and activity of daily living in a short period,with high safety.