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1.
目的 比较激素和溴吡斯的明在眼肌型重症肌无力(MG)患者中的不同疗效,寻找最佳治疗方法.方法 对2001年12月至2009年1月就诊的初次发病的43例眼肌型MG患者资料进行回顾性研究,根据治疗方式分为溴吡斯的明治疗(A)组6例,溴吡斯的明无效后改用泼尼松治疗(B)组16例,泼尼松治疗(C)组21例,分别选择MG临床绝对评分法的眼肌功能评分和相对评分法对每种治疗方法的疗效进行量化比较.结果 泼尼松治疗期(B+C)前后绝对评分差为7.86±4.28,溴吡斯的明治疗期(A+B)为2.64±2.52(t=-5.2,P<0.01);两者的相对评分(分别为0.76±0.32和0.31±0.30,Z=-4.72,P<0.01)及复发病例数(分别为12例和13例,χ~2=4.02,P=0.045)差异有统计学意义.B组和C组治疗前后疗效无明显差异.结论 激素治疗眼肌型MG的效果优于溴吡斯的明,半年内激素治疗的早晚对治疗效果可能无明显影响.  相似文献   

2.
自体外周血干细胞移植抢救重症肌无力危象一例   总被引:3,自引:0,他引:3  
患者女性,42岁,于1998年5月10日无明显诱因出现视物成双,来我院就诊,查体见右眼睑下垂,新斯的明试验(+),肌疲劳试验(+),乙酰胆碱受体抗体(AChR-Ab)(+),胸腺瘤相关抗体(CAE-Ab)(+),以重症肌无力(MG)收入病房。入院后第10天出现吞咽及呼吸困难,予血浆置换治疗。肌无力危象纠正后转胸外科行胸腺切除术,术后病理报告:(胸腔)胸腺瘤(淋巴细胞为主型)。之后7年中因肌无力危象6次住院抢救,每次均使用激素、丙种球蛋白及血浆置换等方法治疗。缓解期在中药、泼尼松、环孢素A、溴吡斯的明等药物的维持下能自理生活。  相似文献   

3.
重症肌无力(MG)是一种自身免疫性神经-肌肉接头疾病,妊娠期的MG患者中约有30.4%出现症状恶化;24.6%出现症状好转;45.0%无明显变化。妊娠期MG人群可能有早产的风险,10%~20%的新生儿会出现MG症状。推荐妊娠期MG人群经阴道分娩,剖宫产仅考虑在有产科指征的情况下进行,通常采用硬膜外麻醉。在妊娠期MG的治疗中,溴吡斯的明、泼尼松、丙种球蛋白被公认为是安全可靠的,在哺乳期也可以使用。  相似文献   

4.
目的探讨西酞普兰合并阿立哌唑治疗老年抑郁症的疗效。方法将60例老年抑郁症患者随机分成西酞普兰组(单用组)和西酞普兰合并阿立哌唑组(合用组)。共观察6周。于治疗前、后1、2、4、6周末采用汉密尔顿抑郁量表(HAMD),不良反应量表(TESS)评定疗效及不良反应。结果治疗第6周末,西酞普兰合用阿立哌唑组疗效显著,合用组与单用组的有效率分别为83.3%和60%,有显著性差异(X^2=4.021,P〈0.05);合用组在1周末起效,单用组在2周末起效;两组治疗后1、2、4周HAMD评分有显著性差异(P〈0.05);TESS评分无明显差异(P〉0.05)。结论西酞普兰合并阿立哌唑治疗老年抑郁症起效快,克服了抗抑郁药起效慢的特点。  相似文献   

5.
目的观察单用不同剂量托吡酯及奥卡西平治疗儿科癫痫患儿的临床疗效和不良反应。探讨单用托吡酯更安全、更有效的给药方法。方法儿科癫痫息儿120例。分为奥卡西平组31例,服用奥卡西平从8~10mg/(kg&#183;d)开始,再逐渐增量到10-30mg/(kg&#183;d),2次/d服用;单用托吡酯组,89例息儿按服药剂量不同又分为低剂量组47例托1组从0.625mg/(kg&#183;d)开始增加至4mg/(kg&#183;d)为止;高剂量组42例托2组从1.5mg/(kg&#183;d)开始,逐增至8mg/(kg&#183;d)为止。结果托1组总有效率81%,托2组总有效率74%;奥卡西平组总有效率77%,3组比较无显著差异(P〉0.05)。托2组不良反应发生率(57%)高于托1组(34%)(P〈0.05)。托吡酯组主要不良反应为胃纳差、头痛、感觉异常、嗜睡和体质量减轻。结论单用较小剂量托吡酯治疗儿科癫痫发作。疗效好。不良反应少。  相似文献   

6.
目的观察强化抗血小板药物氯吡格雷在缺血性脑卒中复发高危患者二级预防中的长期疗效及安全性。方法采用艾森卒中风险评分(ESRS)量表筛选住院的急性非心源性缺血性脑卒中复发高危患者100例,随机分为氯吡格雷组和阿司匹林组,每组50例。两组均给予脑卒中常规治疗,氯吡格雷组予氯吡格雷75mg及阿司匹林100mg口服,1周后仅予氯吡格雷75mg,口服。阿司匹林组予阿司匹林200mg,口服,1周后改为100mg,口服。随访3个月和1年,观察两组缺血性脑卒中复发率及药物不良反应发生率。结果随访3个月时,脑卒中复发率:阿司匹林组为6.3%,氯吡格雷组为2.0%,差异无统计学意义(P〉0.05);药物不良反应发生率:阿司匹林组为14%,氯吡格雷组为2%,差异有统计学意义(P〈0.05)。随访1年时,脑卒中复发率:阿司匹林组为13%,氯吡格雷组为2%,差异有统计学意义(P〈0.05);药物不良反应发生率:阿司匹林组为38%,氯吡格雷组为6%,差异有统计学意义(P〈0.01)。结论缺血性脑卒中复发高危患者二级预防中强化抗血小板治疗可降低脑卒中复发风险,长期应用获益较高,安全性好。  相似文献   

7.
目的 探讨门诊长期使用醋酸泼尼松治疗重症肌无力 (MG)的有效性、安全性和使用方法。方法 对 6 0 0例使用“泼尼松中剂量冲击、小剂量维持”口服疗法的MG患者进行前瞻性研究 ,观察泼尼松使用剂量、撤药方式与疗效和副反应的关系 ,并分析MG类型、年龄、病程及伴发病对疗效的影响。结果 追踪 1~ 12年 (平均约 4年 ) ,总有效率为 94.6 % ,终点的疗效与临床类型、发病年龄、病程及胸腺瘤无明显关联。 2 38例患者按计划撤药 ,有 82例 (34 .5 % )症状复发 (药物依赖 )。主要副反应为Cushing反应和易患上呼吸道感染。结论 泼尼松可用于所有类型MG的长期治疗 ,儿童及成人均适用。Cushing反应随药物减量逐渐消失 ,但易患上呼吸道感染和儿童体格矮小不容忽视。药物依赖的发生率很高 ,自制中成药扶正强筋片对此有一定帮助。  相似文献   

8.
电针合并小剂量米氮平治疗老年抑郁症的疗效观察   总被引:1,自引:0,他引:1  
目的观察电针合并小剂量米氮平治疗老年抑郁症的临床疗效和不良反应。方法随机将60例老年抑郁症患者分为电针合并米氮平治疗(合用组)和单用米氮平治疗(单用组),各30例,治疗6周。采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)和治疗中出现的症状量表(TESS)评定疗效及不良反应。结果两组治疗后HAMD、HAMA评分均较治疗前有显著性差异(P〈0.01);合用组在第1、2周末HAMD及HAMA减分率显著大于单用组,在第4、6周末两组减分率无明显差异;两组的显效率分别为80%和73.3%;主要不良反应合用组比单用组少而轻。结论两组治疗老年抑郁症均有较好疗效,前者起效快,不良反应少,依从性高。  相似文献   

9.
目的:探讨草酸艾司西酞普兰片联合养心汤加减治疗抑郁症的疗效。方法选取我院2014年1~12月收治的抑郁症患者,H A M D总分均≥18分。共入组68例,随机分为研究组和对照组,每组34例。研究组采用草酸艾司西酞普兰片联合养心汤加减治疗,对照组单用草酸艾司西酞普兰片治疗,疗程8周。于治疗前及治疗后第1,2,4,6,8周末采用 HAMD进行临床疗效评定,使用药物治疗不良反应量表(TESS)进行不良反应评定。结果两组患者治疗后 HAMD总分均较治疗前显著下降,治疗8周末研究组较对照组HAMD得分更低,差异均有统计学意义(P<0.05)。研究组治疗总有效率为100.0%,明显高于对照组的82.3%,同时,研究组未出现一例不良反应,明显低于对照组的不良反应发生率14.7%,差异均有统计学意义( P<0.05)。结论采取草酸艾司西酞普兰片联合养心汤加减治疗抑郁症的效果较单用草酸艾司西酞普兰片为佳,起效快,不良反应少。  相似文献   

10.
目的:探讨水蛭素合用阿司匹林治疗短暂性脑缺血发作(TIA)的疗效和安全性。方法:89例TIA患者随机分为3组:(1)氯吡格雷组(n=29),口服氯吡格雷75mg/d:(2)阿司匹林组(n=30),口服阿司匹林100mg/d;(3)水蛭素合用阿司匹林组(n=30),口服水蛭素0.32g,3次/d,阿司匹林100mg/d。观察治疗后90d内TIA复发或进展为脑梗死的病例数,观察出血等不良事件发生率。结果:治疗后90d内总的脑梗死发生率为4.5%,3组之间无显著差异。水蛭素合用阿司匹林组和氯吡格雷组90d内的TIA复发风险分别较单用阿司匹林降低69%(P=0.0078)和65%(P=0.0170)。总的出血发生率为2.25%,均发生在水蛭素合用阿司匹林组。结论:水蛭素合用阿司匹林可降低90d内TIA复发率的效果优于单用阿司匹林,与单用氯吡格雷相似,但出血风险增高。  相似文献   

11.
Recently, there have been many reports on the efficacy and safety of tacrolimus (FK506) treatment for adult patients with intractable generalized myasthenia gravis (MG). There have also been a few reports of successful FK506 therapy in patients with severe childhood-onset generalized MG involving a myasthenic crisis. Herein, we report the efficacy of FK 506 for refractory ocular symptoms in a 3-year-old girl with ocular type MG. Ptosis and alternating strabismus had appeared at 10 months of age. No bulbar signs, respiratory failure or generalized muscle weakness had been seen during her course. Her ocular symptoms had persisted despite repeated steroid pulse therapy, high dose oral prednisolone and thymectomy. Adverse effects of steroids, including obesity, growth retardation, osteoporosis, cataracts and hyperlipidemia, gradually worsened. After obtaining written informed consent from her parents, we started oral tacrolimus at a dose of 0.5 mg/day and her symptoms resolved completely within 3 weeks at a maximum dose of 2.5 mg/day. No adverse effects, such as renal failure or glucose intolerance, were seen. FK506 treatment allowed the steroid dose to be reduced, eliminating its adverse effects. In patients with intractable childhood-onset MG with ocular manifestations, FK506 is an alternative to steroid therapy or thymectomy.  相似文献   

12.
A recent evidence-based review failed to show conclusive benefits of thymectomy in non-thymomatous MG patients, and only recommended thymectomy as an option to increase the probability of remission or improvement. Furthermore, it is a matter of another controversy whether thymectomy is beneficial in ocular MG and also late-onset MG patients without thymoma. We reviewed the clinical course and outcomes of ocular MG and late-onset MG patients in a retrospective cross-sectional multi-center survey conducted in Japan. Our data shows that thymectomy may prevent, or limit the severity of, the generalization of the disease but do not improve ocular symptoms. For late-onset MG, thymectomy is a potentially effective treatment. Another problem is that postoperative course can fluctuate and sometimes postoperative respiratory failure and myasthenic crisis may occur. We described that perioperative steroid therapy is feasible and have clinical benefits for generalized MG with fluctuating symptoms. Mainly after thymectomy, tacrolimus or cyclosporine therapy may allow steroid daily doses to be reduced in MG patients who intended to reduce concomitant steroid use.  相似文献   

13.
Therapeutic options in ocular myasthenia gravis   总被引:3,自引:0,他引:3  
The term ocular myasthenia gravis refers to the disease clinically restricted to extrinsic ocular muscles. It can be disabling as ptosis, and to a greater extent diplopia, both interfere with daily activities. Although ocular disturbances are the most frequent initial complaints in myasthenic patients, symptoms usually progress to generalized disease and only 15% of patients complain of purely ocular weakness for the entire course of their illness. Secondary generalization occurs with the highest frequency in the first 2 years from the onset. Both the severity of symptoms and the risk of generalization should be taken into account when devising a therapeutic plan for these patients. Anticholinesterases are of limited efficacy and a considerable proportion of patients require additional therapy. Corticosteroid therapy, generally prednisone on an alternate-day schedule, is very effective, but a reason for concern is represented by the frequent need for long-term administration with increased risk of severe complications. In patients unresponsive to prednisone or requiring too high dosages, immunosuppressive drugs like azathioprine should be used with the same criteria applied in generalized myasthenia. As corticosteroids and immunosuppressants reduce the chance of generalization, their use is justified in patients with recent-onset disabling disease. In long-standing cases with low risk of generalization, treatment is aimed at the relief of symptoms and pharmacological therapy should be reduced to the minimum effective dosage. The indication for thymectomy in ocular myasthenia remains highly controversial and should be reserved for disabled patients in the early stages of the disease.  相似文献   

14.
Background and PurposeA major concern with ocular myasthenia gravis (MG) is the potential conversion to generalized MG. This study was conducted to determine if the repetitive nerve stimulation (RNS) test could predict the conversion from ocular to generalized MG.MethodsThe RNS test was conducted in a consistent manner on five muscles in the face and limbs in every patient. Subjects were divided into those who remained as ocular MG (ROMG group) and those who experienced conversion to generalized MG during follow-up (GOMG group).ResultsConversion to generalized MG occurred in 24 (21.4%) of 112 MG patients with ocular onset. The proportion of patients displaying abnormal decreases in responses in the trapezius, abductor digiti minimi, or flexor carpi ulnaris muscles on the RNS test was higher in the GOMG group (p<0.001, p=0.002, and p<0.001, respectively). The Cox proportional-hazards model revealed that an abnormal result on the RNS test was significantly associated with conversion to generalized MG [hazard ratio (HR)=3.13, 95% confidence interval (CI)=1.18–8.32]. Notably, the HR was higher for abnormal results on the RNS test for the limb muscles, at 5.19 (95% CI=2.09–12.90).ConclusionsAn abnormal result on the RNS test, especially in the limb muscles, is an independent predictor of the conversion from ocular to generalized MG. Applying the RNS test to limb muscles could be useful for predicting the conversion to generalized MG in patients with ocular onset.  相似文献   

15.
Myasthenia gravis (MG) is a heterogeneous disorder, a fact that needs to be kept in mind when considering treatment. Most patients benefit from pyridostigmine. In nonthymomatous ocular MG, prednisolone is often effective. Thymectomy is indicated for thymoma and is an option for acetylcholine receptor antibody-positive patients with generalized weakness developing under the age of 45 years. In older patients and in those failing to respond to thymectomy, prednisone alone or combined with azathioprine is the treatment of choice. Mycophenolate mofetil is an option in those intolerant of azathioprine. Lambert-Eaton myasthenic syndrome (LEMS) can exist in paraneoplastic (P-) and nonparaneoplastic (NP-) forms. Most patients benefit from 3,4-diaminopyridine. In P-LEMS, treatment of the tumor often results in neurological improvement. In both forms, prednisone alone is an option or combined with azathioprine in NP-LEMS. In both MG and LEMS, where weakness is severe, plasma exchange or intravenous immunoglobulin treatment may provide short-term benefit.  相似文献   

16.
重症肌无力的免疫疗法   总被引:5,自引:1,他引:4  
目的 回顾性分析重症肌无力 (MG)免疫疗法的方法和效果。方法 在 2 385例重症肌无力大样本基础上 ,对不同免疫疗法进行疗效评估 ,并设相应对照组。结果 泼尼松中剂量冲击、小剂量维持疗法治疗 60 0例MG患者 ,总有效率为 94 .6% ;中西医结合治疗组基本痊愈率明显高于对照组 ,复发率显著低于对照组 (P<0 0 1) ;胸腺切除治疗MG ,按围术期处理后 ,死亡率和近期加重反应出现率显著低于对照组 (P <0 0 5)。结论 按患者情况选用不同的免疫疗法 ,可获较好疗效 ,中西医结合治疗MG有良好的治疗前景。  相似文献   

17.
Introduction. When treating ocular myasthenia gravis (MG), the risk/benefit profile of corticosteroids is unclear, and acetylcholinesterase inhibitors are not very effective. We examined the efficacy of topical naphazoline in the treatment of myasthenic blepharoptosis. Methods. Sixty MG patients with blepharoptosis (32 with ocular symptoms only and 28 with mild generalized symptoms) were enrolled in a multicenter open trial of topical naphazoline. The effects were reported by patients via a questionnaire and were also confirmed for each patient at the clinic. Results. Among 70 eyes of 60 patients, 20 eyes (28.6%) of 17 patients (28.3%) exhibited a marked response (full eye opening), and 24 eyes (34.3%) of 20 patients (33.3%) showed a good response (adequate but incomplete eye opening). Topical naphazoline was evaluated as useful in the treatment of myasthenic blepharoptosis by >70% of the patients. Conclusions. Topical naphazoline was found to be an effective supplementary symptomatic treatment for myasthenic blepharoptosis. Muscle Nerve 44: 41–44, 2011.  相似文献   

18.
BACKGROUND: Generalized myasthenia gravis will develop in more than 50% of patients who present with ocular myasthenia gravis, typically within 2 years. The optimal treatment of ocular myasthenia gravis, including the use of corticosteroids, remains controversial. In addition, the prevalence of thymoma and the optimal performance of the edrophonium chloride test for ocular myasthenia remain unknown. OBJECTIVE: To assess the effect of oral corticosteroid therapy on the frequency of development of generalized myasthenia gravis within 2 years, the incidence of thymoma, and the amount of edrophonium needed for a positive test result in patients with ocular myasthenia gravis. METHODS: We reviewed an ocular myasthenia gravis database of 147 patients. Patients underwent measurement of acetylcholine receptor (AChR) antibody levels and chest computed tomography. Unless contraindicated, patients with diplopia were recommended for therapy with prednisone, up to 40 to 60 mg/d, with the dosage tapered for 5 to 6 weeks. Most continued to receive daily or alternate-day doses of 2.5 to 10 mg to prevent diplopia. Patients not given prednisone (untreated group) received pyridostigmine bromide or no medication. After the diagnosis, we documented the signs and symptoms of ocular and generalized myasthenia gravis and performed 2-year follow-up in 94 patients. RESULTS: The mean dose of edrophonium chloride to give a positive response was 3.3 mg (SD, 1.6 mg) for ptosis and 2.6 mg (SD, 1.1 mg) for ocular motor dysfunction. Thymoma occurred in 1 patient (0.7%). Generalized myasthenia gravis developed within 2 years in 4 of 58 treated and 13 of 36 untreated patients. The odds ratio (OR) for development of generalized disease in the treated group was 0.13 (95% confidence interval [CI], 0.04-0.45) compared with the untreated group. The AChR antibody level was not predictive of development of generalized myasthenia gravis at 2 years, but the risk was greater in patients with abnormal AChR antibody levels (OR, 6.33; 95% CI, 1.71-23.42). Logistic regression that included age, abnormal AChR antibody level, and prednisone therapy yielded significance only for abnormal AChR antibody level (OR, 7.03; 95% CI, 1.35-36.64) and treatment (OR, 0.06; 95% CI, 0.01-0.30). CONCLUSIONS: At 2 years, prednisone treatment appears to reduce the incidence of generalized myasthenia gravis to 7% in contrast to 36% of patients who did not receive prednisone. Thymoma, although uncommon, occurs in ocular myasthenia gravis. Only small amounts of edrophonium are needed to diagnose ocular myasthenia gravis.  相似文献   

19.
血浆置换(plasma exchange,PE)在重症肌无力(MG)上的疗效已有报道,但缺乏明确一致的置换方案。我们对12例MG患者进行了37人次的短程PE,各例均在10d内行3~4次置换术,术前和术后第7天按Mantegazza肌力评分表进行临床疗效评定,结果除1例外,均获得肯定疗效,仅1人次发生较严重的副反应。4例抗体阴性病人置换后均获显著疗效,提示抗体阴性MG血浆中存在某些未知的致病因子。短程PE可供选择作为MG危象的治疗方案。  相似文献   

20.
We assayed cryopreserved sera from 38 acetylcholine receptor (AChR) antibody-negative patients with myasthenia gravis (MG) who were followed clinically for muscle-specific tyrosine kinase (MuSK) antibodies and analyzed and compared their clinical characteristics. None of 13 sera from patients with purely ocular MG were positive. Sera from 10 of 25 patients (40%) with generalized MG were positive for MuSK antibodies. The age at onset of myasthenic symptoms was significantly earlier in MuSK antibody-positive patients (P = 0.02). MuSK antibodies were present in AChR antibody-negative patients of either gender, with virtually identical prevalence in women (41.2%) and men (37.5%). The distribution of weakness more commonly involved neck muscles in MuSK antibody-positive patients, and limb muscles in MuSK antibody-negative patients. Patients responded to immunosuppressive treatment regardless of whether MuSK antibody was present. We conclude that MuSK antibodies are present and diagnostically useful in a subset of myasthenic patients without AChR antibodies. Although the distribution of weakness differs somewhat depending on whether MuSK antibodies are present, responses to anticholinesterase and immunosuppressive treatments are similar.  相似文献   

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