胸腺切除术在重症肌无力治疗中的地位

目的 评估胸腺切除术治疗重症肌无力(MG)的疗效.探讨个体化中西医治疗方案.方法 21例患者均在手术前后口服强的松、溴化吡啶斯的明,中医中药控制无力症状,均行扩大胸腺切除术,术后继续行中西医的内科治疗,1年以后评定疗效.结果 总有效率83%,无效17%,术后早期发生肌无力危象3例,无手术死亡者.结论 胸腺切除术结合中西医内科治疗重症肌无力疗效满意.     

重症肌无力的中西医治疗进展

重症肌无力(myasthenia gravis,MG)是一种难治性自身免疫性疾病,近年来随着国内外医疗水平的不断提高,对MG的治疗有了深入认识,并取得了一定的研究进展。仅用单一的中医或西医方法治疗MG可能很难取得显著疗效,而采用中西医结合的治疗方法能够同时发挥中医和西医各自的优势,改善患者的预后,提高患者的生活质量。本文对中医治疗、西医治疗和中西医结合治疗MG的国内外研究进展进行综述。     

免疫抑制剂对重症肌无力病人T淋巴细胞亚型的影响

目的观察重症肌无力(MG)病人细胞免疫的异常改变和免疫抑制剂对重症肌无力(MG)病人的临床疗效及对T淋巴细胞亚型的影响。方法用许氏评分法观察60例MG病人的病情严重程度和免疫抑制治疗2个月后的临床疗效;采用直接免疫荧光染色和流式细胞仪技术测定60例病人和60名志愿健康者周围血中T淋巴细胞亚型的百分率,并测定糖皮质激素或环磷酰胺免疫抑制治疗前及治疗后2个月T淋巴细胞亚型的变化。结果未治疗MG组外周血中CD8 T淋巴细胞的百分率较正常对照组显著下降(P<0.01);CD4 T淋巴细胞的百分率和CD4 /CD8 T细胞的比例较正常对照组均显著升高(P<0.01)。经激素或环磷酰胺治疗2个月后MG组随着临床症状的改善,外周血中总T细胞(CD3 )和CD8的百分率较治疗前均显著升高(P<0.01;P<0.05);CD4 T淋巴细胞的百分率和CD4 /CD8 T细胞的比例较治疗前均显著下降(P<0.01)。结论MG病人有T淋巴细胞亚型的变化,免疫抑制治疗对T淋巴细胞亚群有明显影响,提示T淋巴细胞亚型的测定可为激素、环磷酰胺等免疫疗法提供一个客观的实验室指标,为判断疾病的转归提供实验依据。     

重症肌无力患者CD40配体高表达及其临床意义

目的:研究重症肌无力(MG)患者CD40配体(CD40L)的表达,探讨CD40L在MG中的作用。方法:25例MG患者,分为急性期组13例,非急性期组12例,设正常对照组15例。分离血中单个核细胞,分别培养并用不同刺激剂(PHA、PMA和A23187)刺激。培养前后用流式细胞仪检测CD40L阳性细胞率。结果:①MG急性期组CD40L阳性细胞率比正常对照组及非急性期组显著增高(均为P<0.01);②经PHA或PMA和A23187刺激后,非急性期组CD40L阳性细胞率也比正常对照组显著增高(P<0.01)。结论:CD40L的高表达与MG发生和加重有关。     

大剂量糖皮质激素冲击治疗重症肌无力80例临床分析

目的观察大剂量糖皮质激素冲击治疗重症肌无力的临床效果。方法将80例重症肌无力患者随机分为对照组和观察组,分别采用小剂量递增与大剂量冲击治疗,比较2组治疗效果、重症肌无力改善情况及治疗过程中不良反应发生情况。结果观察组疗效良好率显著高于对照组,观察组治疗后肌无力评分显著低于对照组,2组并发症发生率差异无统计学意义(P0.05)。结论大剂量糖皮质激素冲击治疗重症肌无力临床效果显著,不良反应发生率低,值得临床推广应用。     

中国人(汉族)MG患者FcγRⅢB基因多态性分析

目的探讨FcγRⅢB基因多态性在中国(汉族)重症肌无力(myastheniagravis,MG)患者中的分布特征与其免疫治疗疗效的关系。方法选取70例MG患者和40例中青年卒中患者的全血,提取DNA后运用基因序列特异性PCR扩增技术(PCRSSP)测定FcγRⅢB基因多态性的表达,比较基因型和等位基因在不同临床特点亚组以及不同疗效亚组的分布。结果MG患者基因型及等位基因分布频率与对照组间差异无显著性(P>005)。I型MG患者NA1纯合子的分布频率较高(P=00617)。MG患者激素治疗有效组基因型和激素治疗无效组比较差异有显著性(P<001),MG患者激素治疗有效组基因型和对照组间差异也有显著性(P<001),MG患者激素治疗有效组的NA1纯合子分布频率高于对照组。结论MG患者NA1纯合子与激素疗效较好相关,且该基因型在轻型MG患者中表达高可能是其疗效较好的原因,亦可能是MG的一个保护性因子。     

黄芪复方对重症肌无力患者血清乙酰胆碱受体抗体水平的影响

目的采用中药黄芪复方调节重症肌无力(myastheniagravis,MG)患者血清乙酰胆碱受体抗体(acetylcholinereceptorantibody,AChRAb)水平,以探讨其治疗MG的可能作用机制。方法应用酶联免疫吸附法(ELISA)检测74例MG患者治疗前后血清AChRAb水平,并采用许(氏)临床绝对和相对记分法观察病情严重程度和判定中药复方疗效。结果MG患者治疗前血清AChRAb水平(108±007)显著高于健康对照组(016±011)(P<001),治疗后MG患者血清AChRAb水平(072±006)明显下降(P<001)。结论具有补益脾肾作用的中药黄芪复方能下调MG患者血清AChRAb水平,从而纠正MG患者免疫失衡状态,临床绝对记分和相对记分对其疗效的判定有一定意义。     

重症肌无力患者的心肌酶及心电图分析

目的　探讨重症肌无力 (MG)患者的心脏损害。方法　对 1 0 3例MG患者空腹取血查心肌酶 ,心电图检查。结果　 1 0 3例MG患者中心肌酶异常率 2 6 2 % (2 7/ 1 0 3) ,心电图异常率 2 3 3 % (2 4 / 1 0 3)。伴胸腺瘤的MG患者与不伴胸腺瘤的MG患者之间的心肌酶异常率及心电图异常率均有显著性差异 (P <0 0 5)。眼肌型患者与全身型患者之间的心肌酶异常率及心电图异常率均无显著性差异 (P >0 0 5)。结论　MG患者伴有心脏损害 ,尤其伴胸腺瘤的MG患者。心肌酶及心电图检查可提示MG患者的心脏损害。     

免疫冲击加机械通气抢救重症肌无力危象的研究

目的研究重症肌无力(MG)危象的有效治疗方法,提高MG危象抢救的成功率和缩短机械通气的时间。方法应用静脉注射丙种球蛋白(IVIG)、甲基强的松龙、环孢霉素A及机械呼吸治疗3例重症肌无力危象患者,根据临床症状判断疗效。结果3例MG危象患者症状缓解,随诊6个月~2年,3例可以正常生活。结论IVIG、甲基强的松龙、环孢霉素A联合治疗加机械呼吸是治疗MG危象的有效措施。     

152例甲状腺机能亢进伴重症肌无力的临床疗效分析

目的回顾性分析甲状腺机能亢进伴重症肌无力(myasthenia gravis,MG)的各种不同治疗方案的疗效。方法对152例甲状腺机能亢进伴MG患者的各种治疗方案的疗效进行评估,比较患者有效率、基本痊愈率及不良反应。结果 (1)131I组的有效率比其它治疗组都显著性升高(P<0.05),而它的甲状腺机能减退发生率比甲状腺切除组低(P<0.05);(2)在I型MG的各种治疗方案中,D组(泼尼松+吡啶斯的明)、E组(泼尼松+吡啶斯的明+参芪扶正)总有效率都分别比A组(吡啶斯的明)、B组(泼尼松)及C组(泼尼松+参芪扶正)显著性提高(P<0.05);E组基本痊愈率最高(P<0.05)。在II型MG患者中,D、E组之间总有效率无显著性差异(P>0.05);E组基本痊愈率比D组高(P<0.05);(3)在I型MG的各种治疗方案中,A、C、E组不良反应发生率分别比B、D组显著性降低(P<0.05)。在II型MG患者中,E组不良反应发生率比D组显著性降低(P<0.05)。结论对于甲状腺机能亢进伴MG患者而言,口服131I是一种较好的治疗甲状腺机能亢进的方法,而皮质类固醇泼尼松联合抗胆碱酯酶药吡啶斯的明及中药参芪扶正的中西医结合疗法是治疗MG的一种较好的措施。     

不同类固醇激素应用方式治疗小儿面神经麻痹的临床研究

目的探讨不同肾上腺皮质激素应用方式治疗儿童面神经麻痹的临床效果差异。方法将50例面神经麻痹患儿随机分为2组,一组给予大剂量甲基强的松龙静脉冲击治疗,另一组给予常规强的松口服治疗作为对照,比较2组患儿治疗后恢复时间、治愈率及不良反应情况。结果治疗组患儿平均恢复时间（14.08±5.9）d,而对照组为（19.48±8.32）d,治疗2周后治疗组患儿治愈率68%,而对照组为40%,两者差异有统计学意义（P〈0.05）。2组不良反应发生率差异无统计学意义。结论大剂量甲基强的松龙冲击治疗儿童面神经麻痹效果明显,症状改善迅速,未见不良反应增加。     

中药复方扶正强筋片治疗重症肌无力的前瞻性研究

目的 探讨复方中药制剂扶正强筋片治疗重症肌无力（MG）的有效性、安全性及使用时机。方法 收集2004-02—2004-04确诊的164例MG患者，随机分为A组（泼尼松＋溴吡斯的明）、B组（泼尼松＋溴吡斯的明＋扶正强筋片）和C组（扶正强筋片），评估扶正强筋片的起效时间、疗效、使用时机及其不良反应。结果 单用扶正强筋片组于治疗后1个月左右起效，至观察终点有效率为46．9％；扶正强筋片在泼尼松减量或停药时能明显减少患者复发率，B组（10．5％）和C组（6．67％）复发率明显低于A组（31．3％）（P〈0．01），并能减少上呼吸道感染的发生率，且无明显不良反应。OssermanⅠ型患者疗效与性别、年龄及伴发病无明显相关性。结论 单用扶正强筋片治疗MG疗效不肯定，但与泼尼松联用能减少不良反应发生，在泼尼松减量或者停药时可有效预防症状反跳。     

Effects of Jisuikang on hemorheology and inflammatory factors in rats following spinal cord injury

BACKGROUND: Trauma can damage the spinal cord or cauda equina to different degrees. Previous studies have verified that traditional Chinese medicine has effects on spinal cord injury via a variety of pathways. OBJECTIVE: To observe changes in hemorheology and inflammatory factors in spinal cord injury rats following treatment with the Chinese medicine Jisuikang, to verify the dose-dependent effect of Jisuikang, and to compare its effects with the effects of prednisone. DESIGN, TIME AND SETTING: A randomized study was performed at the Research Institute of Orthopedics, and Experimental Center of First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, China from September 2007 to March 2008. MATERIALS: Jisuikang powdered extract, composed of milkvetch root (30 g), Chinese angelica (12 g), red peony root (12 g), earthworm (10 g), szechwan lovage rhizome (10 g), peach seed (10 g) and safflower (10 g), was provided by the Experimental Center, First Clinical Medical College, Nanjing University of Traditional Chinese medicine. Each gram of powdered extract was equivalent to 6.47 g crude drug. METHODS: A total of 72 Sprague Dawley rats were randomly assigned into 6 groups (n = 12). Rat models of spinal cord injury were established using the occlusion method. Rats in the model group were treated with distilled water. Rats in the 25 g/kg, 12.5 g/kg, and 6.25 g/kg Jisuikang groups were given 25 g/kg, 12.5 g/kg, or 6.25 g/kg Jisuikang by gavage, for 14 days. Rats in the prednisone group received 0.06 g/kg prednisone by gavage, for 7 days. Rats in the normal group were given the same volume of distilled water. The volume of administration was 15 mL/kg.MAIN OUTCOME MEASURES: Rat serum interleukin-10, tumor necrosis factor-α (TNF-α), nitric oxide, nitric oxide synthase levels, malondialdehyde content, superoxide dismutase activity and whole blood viscosity were measured in each group. Spinal cord around the site of the model was collected. Half the spinal cord was used for histopathologic examination. The other half was used for measurement of nitric oxide and NOS levels, malondialdehyde contents, and superoxide dismutase activity. RESULTS: Superoxide dismutase activity was higher in the 25 g/kg Jisuikang group than in the model group. Malondialdehyde contents, nitric oxide and NOS levels were lower in the 25 g/kg and 12.5 g/kg Jisuikang groups compared with the model group. Whole blood viscosity was lower in the 25 g/kg and 12.5 g/kg Jisuikang groups compared with the model group (P < 0.05-0.01). Serum TNF-α content was lower in each Jisuikang group compared with the model group (P < 0.05-0.01). Serum interleukin-10 levels were greater in the prednisone group and each Jisuikang group compared with the model group (P < 0.01). Mild hemorrhage and necrosis in the rat spinal cord, and unclear neural cell swelling were seen in the 25 g/kg Jisuikang group. Severe hemorrhage and necrosis in the rat spinal cord, and distinct neural cell swelling were seen in the 12.5 g/kg Jisuikang group. Edema in the white matter was found in the 6.25 g/kg Jisuikang group. Pathological changes in the prednisone group were identical to the 25 g/kg and 12.5 g/kg Jisuikang groups. CONCLUSION: Jisuikang inhibits nitric oxide synthase expression, reduces nitric oxide and TNF-α levels, decreases malondialdehyde content, increases interleukin-10 levels and superoxide dismutase activity, improves indices of hemorheology, and prevents secondary changes in spinal cord injury, resulting in relieving pathological changes in spinal cord tissue. The outcome was significant in the 25 g/kg Jisuikang group compared with the 12.5 g/kg Jisuikang group.     

A randomised clinical trial comparing prednisone and azathioprine in myasthenia gravis. Results of the second interim analysis. Myasthenia Gravis Clinical Study Group.

From January 1983 to October 1990, 41 patients with generalised myasthenia gravis were randomly given either prednisone or azathioprine. The main goal was to record the time to the occurrence of the first episode of deterioration. During a mean follow-up of 30 months, 21 patients showed deterioration, 12 in the prednisone group and nine in the azathioprine group (p = 0.40). No difference was observed between the two groups in muscular score and functional grade, assessed at the end of each treatment year, or in tolerance. Treatment failure occurred in 17 patients, 12 in the prednisone group and five in the azathioprine group (p = 0.02); even after adjustment for imbalances in prognostic features, the failure rate remained 2.8 times higher in the prednisone group than in the azathioprine group (p = 0.5). In the patients in whom treatment failed, symptoms were initially more severe than in the others, but the combination of prednisone and azathioprine resulted in clinical improvement, consisting of remission or only minor deficits in half of the patients after two years of treatment. These findings indicate that azathioprine increases treatment response compared with prednisone, although no difference in the duration of improvement was demonstrated. Nevertheless, it appears that the most severe forms of the disease, often resistant to prednisone or azathioprine alone, could benefit from the combination of both drugs.     

Mononuclear cell analysis of muscle biopsies in prednisone-treated and untreated Duchenne muscular dystrophy. CIDD Study Group

A recent double-blind, placebo-controlled trial has shown that prednisone improves strength in patients with Duchenne muscular dystrophy. To determine whether immunosuppressant effects were important in mediating this improvement, we performed immunohistochemical analyses on muscle biopsies obtained at the conclusion of the trial. We studied 33 patients: 12 from the placebo group, nine from the low-dose prednisone group (0.75 mg/kg/d), and 12 from the high-dose group (1.5 mg/kg/d). There was a significant difference in total T cells (CD2+) between the placebo group and both treatment groups. Similarly, the number of CD8+ cytotoxic/suppressor T cells was significantly decreased in both treated groups compared with placebo. The number of muscle fibers focally invaded by lymphocytes was also significantly decreased in the two treated groups compared with controls. There were no differences between the low- and high-dose groups. The numbers of B cells, natural killer cells, CD4+ cells, macrophages, and necrotic muscle fibers were not significantly different in the treated and control groups. This study suggests that prednisone may improve strength in Duchenne muscular dystrophy through primarily immunologic mechanisms involving T lymphocytes.     

A comparison of daily and alternate-day prednisone therapy in the treatment of Duchenne muscular dystrophy

We previously reported the results of a randomized, double-blind 6-month trial of prednisone therapy in which 102 boys aged 5 to 15 years with Duchenne muscular dystrophy received daily doses of 1.5 and 0.75 mg/kg per day and were compared with those receiving placebo. The strength and function in both prednisone-treated groups improved equally and were significantly better than in the placebo group. To compare alternate-day and daily dosing of prednisone with respect to benefits and adverse side effects, the placebo group was started on alternate-day prednisone therapy, and the treatment group regimens were changed to equivalent doses of alternate-day prednisone without breaking the double-blind nature. At the end of 6 months, the group that was changed from daily to alternate-day therapy had declined in strength back to levels observed 12 months previously, at the start of daily therapy. The group in which alternate-day therapy was started showed a significant improvement in strength at 3 months, similar in magnitude to the response of boys treated with daily therapy. However, their strength declined significantly in the subsequent 3 months compared with boys who received daily therapy. The frequency of side effects was not significantly different for alternate-day therapy compared with daily therapy. We conclude that alternate-day prednisone therapy effectively increases strength but does not sustain the improvement to the same extent as daily therapy or mitigate side effects.     

来氟米特用于肾移植患者长期维持治疗20例

背景：来氟米特作为一种新型免疫抑制剂广泛应用于治疗自身免疫性疾病,它兼有免疫抑制作用和抗病毒活性,初步临床观察提示它可用于器官移植抗排斥治疗,但长期疗效尚不清楚。 目的：评价来氟米特+环孢霉素(或他克莫司)+泼尼松三联药物对肾移植受者维持治疗的长期效果。 设计、时间及地点：回顾性病例分析,2002-12/2007-03在解放军第四五五医院,解放军南京军区肾脏专科中心完成。 对象：选取肾移植术后超过1个月且肾功能正常者。来氟米特治疗组：用氟米特替换霉酚酸酯或硫唑嘌呤患者20例,移植时年龄16~47岁,平均(32.6±8.7)岁,其他免疫抑制剂与对照组相同。对照组：同期肾移植患者41例,年龄17~57岁,使用霉酚酸酯+环孢素A/他克莫司+泼尼松为维持治疗。 方法：来氟米特起始剂量为50 mg/d,应用3~5 d后给予20 mg/d 维持;泼尼松维持剂量为10 mg/d;环孢素A或他克莫司剂量根据其血药浓度进行调整。前3个月每月复查肝功能、肾功能和血常规,以后根据患者情况1~3个月复查1次。 主要观察指标：来氟米特治疗组和对照组移植肾和患者生存率,及来氟米特不良反应。 结果：来氟米特组观察时间平均(27.7±21.6)个月。继续维持来氟米特治疗肾功能稳定7例,血肌酐翻倍或肾功能丢失2例,失访1例,退出10例。来氟米特组人、肾生存率分别为1年100%和100%,3年100%和94%,5年79%和78%。对照组人、肾生存率分别为1年95%和95%,3年90%和88%,5年90%和77%。死亡原因：来氟米特组2例移植肾失功后放弃透析治疗;霉酚酸酯组2例带功死于肺部感染,2例于移植肾失功后因经济困难放弃治疗。来氟米特不良反应：早期脱发3例,皮疹2例,恶心3例,贫血2例。 结论：用来氟米特+钙调素抑制剂+泼尼松三联治疗和霉酚酸酯+钙调素抑制剂+泼尼松三联治疗的肾移植受者5年的临床结果无明显差别。     

Early prednisone treatment in Duchenne muscular dystrophy

The purpose of this long-term, open parallel-group, double-consent study of alternate-day, low-dose prednisone in 2-4-year-old patients with Duchenne muscular dystrophy (DMD) was to determine whether prednisone produces a beneficial effect when given earlier than usual. Muscle function was evaluated by timed tests, and muscle strength with a hand-held myometer. After 55 months of treatment, the five patients (mean age 8.3 years) in the prednisone group were still able to get up from the floor, whereas two of the three in the control group had lost this ability. Side effects included a decline in growth rate in the prednisone-treated patients and excessive weight gain in one control and three treated patients. Because steroids are effective in prolonging function, but not in recovering lost function, we propose that treatment be started with low-dose prednisone in DMD patients as soon as the diagnosis is definite.     

活血化瘀中药治疗眼睑带状疱疹后遗神经痛临床观察

目的观察中药桃红四物汤联合西药治疗眼睑带状疱疹后遗神经痛(PHN)的临床疗效。方法回顾性研究我院眼科近年来收治的60例眼睑PHN患者,根据治疗方法分为对照组和治疗组各30例。对照组给予阿昔洛韦注射液静滴,1次/d,连用1周,布洛芬片和甲钴胺片口服,3次/d,连用2周;治疗组在对照组基础上加用中药桃红四物汤水煎服,1剂/d,连用2周。治疗2周后,比较2组治疗前后疼痛程度视觉模拟评分(VAS)和睡眠质量评分(QS),以及临床疗效。结果治疗1周和2周后,2组VAS评分均逐渐降低,且治疗组低于对照组(P0.05);2组QS评分均逐渐降低,且治疗组高于对照组(P0.05)。治疗组临床总有效率83.4%,高于对照组的63.4%(P0.05)。治疗组在有效率、减轻疼痛症状及改善睡眠质量等方面均优于对照组。结论中药桃红四物汤联合西药治疗眼睑PHN疗效肯定,安全性好。     

A randomized controlled trial of prednisone in Alzheimer's disease. Alzheimer's Disease Cooperative Study

BACKGROUND: Laboratory and epidemiologic studies suggest that anti-inflammatory/immunosuppressive therapy may be useful in the treatment of AD. In preliminary studies, a regimen of low to moderate dose prednisone was found to suppress peripheral inflammatory markers without adverse effects in subjects with AD. METHODS: We conducted a randomized, placebo-controlled multicenter trial to determine whether prednisone treatment slowed the rate of cognitive decline in AD. The active treatment regimen consisted of an initial dose of 20 mg of prednisone daily for 4 weeks tapered to a maintenance dose of 10 mg daily for 1 year, followed by gradual withdrawal during an additional 16 weeks. The primary outcome measure was the 1-year change in the cognitive subscale of the AD Assessment Scale. RESULTS: A total of 138 subjects were randomized to the drug and placebo groups. There was no difference in cognitive decline between the prednisone and placebo treatment groups in the primary intent-to-treat analysis, or in a secondary analysis considering completers only. Subjects treated with prednisone showed behavioral decline compared with those in the placebo group. CONCLUSION: A low-dose regimen of prednisone is not useful in the treatment of AD.