大剂量甲基维生素B12治疗多发性硬化急性期的疗效观察

目的探讨大剂量甲基维生素B12对复发缓解型多发性硬化（MS）急性期的疗效。方法72例随机分为甲泼尼龙加大剂量甲基维生素B12组36例（观察组）及甲泼尼龙组36例（对照组），比较2组的有效率、治疗前后扩充致残量表（EDSS）平均评分及神经电生理包括体感诱发电位（SEP）、脑干听觉诱发电位（BAEP）、视觉诱发电位（VEP）的变化。结果治疗7d时2组治疗前后EDSS评分均显著降低（均P〈0．001），有效率对照组为69．4％、观察组为75．0%，比较2组有效率和治疗后EDSS评分均无显著性差异（均P〉0．05）。治疗30d时观察组有效率为97．2%，明显高于对照组的77．7％（P〈O．05）；观察组EDSS评分也较对照组明显降低（P〈O．05）。诱发电位在治疗7d时2组总的改善率无差别（P〉0．05），在治疗30d时2组有显著性差异（P〈O．05），尤其在VEP、BAEP改善明显（P〈O．01）。结论甲泼尼龙加用大剂量甲基维生素B12治疗急性期多发性硬化，能提高有效率，促进神经功能的恢复，且长程使用效果可能更佳。大剂量甲基维生素B12可以作为免疫抑制治疗急性期多发性硬化的辅助治疗。     

乌司他丁与甲基强的松龙对急性肺挫伤的保护作用

【目的】探讨鸟司他丁(UTI)与甲基强的松龙(MP)对急性肺挫伤的保护作用。【方法】分别设UTI MP治疗组与对照组各18例,观察治疗后TNF-α、IL-6胸片变化。【结果】治疗组X线胸片吸收率优于对照组;TNF—α、IL-6治疗组低于对照组。【结论】UTI MP对挫伤的肺组织有保护作用。     

多发性硬化的肾上腺皮质激素治疗

多发性硬化是一种发生于中枢神经系统的、主要由细胞免疫介导的自身免疫性疾病.近年来国外数项多中心、随机、双盲、安慰剂对照的前瞻性临床研究的结果显示,肾上腺皮质激素(激素)对多发性硬化急性期疗效肯定,可作为治疗多发性硬化急性发作和复发的主要药物.该文就多发性硬化的激素治疗相关内容作一概述,以供临床参考.     

甲基强的松龙治疗44例多发性硬化

大剂量甲基强的松龙(Methylprednisolone MPS)冲击治疗神经系统免疫性疾病,近几年来临床应用广泛。我院近5年用此法治疗44例多发性硬化(Multiple Scle-nosis,MS),现报告如下。     

甲基强的松龙冲击疗法治疗多发性硬化的护理体会

多发性硬化是一种特定性地针对中枢神经系统白质、导致其脱髓鞘的自身免疫病。临床常表现为广泛的神经系统功能缺失，病程呈阵发性地复发与缓解交替发生，总的趋势是病情逐步恶化。在治疗上应用大量皮质激素，时间长，副作用大，复发率高，给病人带来极大痛苦。我科从1996年～1998年2月收治68例此类病人，采用甲基强的松龙冲击治疗，取得较满意疗效。现将护理体会报告如下。1临床资料1．1病例选择本组68例，男18例，女50例，最大年龄59岁，最小年龄16岁，平均年龄38岁，其中视力减退19例，双眼复机40例，肢体无力60例，感觉障碍45例，共济失…     

甲基强的松龙致过敏性反应1例

1病历摘要女,5岁。因哮喘反复发作2a,加重伴发热5d人院。既往经常口服氨茶碱、非那根、复方甘草合剂及罗红霉素,亦曾多次静脉滴注氨茶碱及大环内酯类药物,未见不良反应。入院后查体：T38．5℃,R30次／min,BP110／70mmHg,精神弱,呼吸稍促,双肺布满哮鸣音,两肺底深吸气未可闻及细湿性哕音,心音有力,律齐,HR130次／min,未闻及杂音,肝右肋下2．0cm,质软边锐,     

甲基强的松龙致血钾低1例分析

对甲基强的松龙致血钾低1例分析如下。     

甲基强的松龙治疗毛细支气管炎疗效观察

目的：观察甲基强的松龙治疗毛细支气管炎的疗效。方法：将357例毛细支气管炎患儿分为甲基强的松龙组180例及地塞米松组177例,观察两组患儿在治疗前后咳嗽、喘憋等临床症状的缓解时间、肺部哮鸣音消失时间及平均住院日分别进行比较。结果：在咳嗽、喘憋、肺部哮鸣音消失时间及住院日等方面与对照组比较差异均有统计学意义（P〈0.01）。结论：小剂量甲基强的松龙治疗毛细支气管炎疗效好、显效快,可作为此类患儿的用药选择。     

甲基强的松龙冲击疗法治疗急性脊髓炎16例分析

目的：总结分析16例急性脊髓炎的临床与治疗效果。方法：采用甲基强的松龙冲击疗法结合营养神经、改善循环、加强护理、防止并发症等综合治疗。结果：16例患者中治愈7例（43．7％），好转9例（57．3％），病死率：0，总有效率为100％，平均住院日：32．8d。结论：甲基强的松龙冲击疗法治疗急性脊髓炎效果显著，值得推广。     

甲基强的松龙对大鼠脊髓损伤组织C9和CD59表达的影响

背景：甲基强的松龙(methylprednisolone，MP)在脊髓损伤治疗中的作用现已得到国际公认，但其作用机制复杂，且目前并没有完全被揭示。目的：探讨MP对大鼠脊髓损伤组织C9和CD59表达的影响。设计：随机分组、实验对照、前瞻性研究。地点和对象：实验地点为中国医科大学，实验对象为50只体质量250-300g健康SD大鼠。干预：50只SD大鼠随机抽签法分MP组和生理盐水组，采用改良Allen重物打击法制成SD大鼠急性脊髓损伤模型，于伤后12h，1，3，5，7d对脊髓损伤组织取材制成性冷冻切片，进行苏木精-伊红(HE)染色、C9和CD59免疫组化染色，半定量法图像分析。主要观察指标：观察各组伤后各时间点脊髓损伤组织的变性坏死、中性粒细胞浸润及C9，CD59阳性反应物的表达部位及时程。结果：MP组在伤后12h，1，3，5，7d时间点C9阳性表达均明显轻于生理盐水组，分别为87．82&;#177;4．16，82．13&;#177;3．84，65．91&;#177;4．04，82．69&;#177;6．15，95．53&;#177;7．49，且差异有显著性意义(t=3．70，6．61，3．43，5．62，4．08，P&;lt;0．01)；MP组在伤后12h，1，3d时间点CD59的表达明显轻于生理盐水组，分别为102．52&;#177;8．03，93．45&;#177;7．24，73．86&;#177;5．32，且差异有显著性意义(t=3．05，P&;lt;0．01，t=2．41，2．27，P&;lt;0．05)，伤后5，7d时间点两组间无显著性意义。结论：MP可通过抑制补体系统激活机制减轻继发性脊髓损伤。     

多发性硬化40例临床分析

[目的]探讨多发性硬化(MS)的临床特点、诊断及治疗.[方法]对40例MS患者的临床表现、辅助检查及预后等资料,结合文献进行回顾分析.[结果]MS以青壮年女性多见,以急性、亚急性起病为主;首发症状以视力障碍最常见(47.5%);大脑半球、视神经、脊髓受累的症状、体征最多见.MRI有助于早期诊断.甲基强的松龙的疗效好于地塞米松.[结论]本组MS临床特点不同于西方人,提高对MS临床症状、体征的认识,及时的MRI检查有助于早期诊断,激素治疗对大多数病人有效.     

Treatment Patterns in Disease-Modifying Therapy for Patients With Multiple Sclerosis in the United States

Background

Patients with multiple sclerosis (MS) whose disease activity is inadequately controlled with a platform therapy (interferon beta or glatiramer acetate [GA]) may switch to another platform therapy or escalate therapy to natalizumab or fingolimod, which were approved in the US in 2006 and 2010, respectively.

Objective

The objective of this study was to describe treatment patterns in patients with multiple sclerosis (MS) in the United States who were followed for 2 years after initiating a disease-modifying therapy (DMT).

Methods

A retrospective observational cohort study was conducted to examine treatment patterns of initial DMT use (on initial therapy for 2 years with and without gaps of ≥60 days, medication switching, and discontinuation) among patients with MS who initiated a platform therapy (interferon-β or glatiramer acetate) or natalizumab between January 1, 2007, and September 30, 2009; the first DMT claim was the index. Eligible patients were identified in the MarketScan Commercial and Medicare Supplemental databases based on continuous enrollment for 6 months before (preindex period) and 24 months after their index date, with a diagnosis of MS and no claim for a previous DMT in the 6-month preindex period. Demographics at index and clinical characteristics during the preindex period were also analyzed.

Results

A total of 6181 MS patients were included, with 5735 (92.8%) starting on platform therapy. Natalizumab initiators were more likely to stay on index therapy (32.3% vs 16.9%, P < 0.001) and have fewer treatment gaps of ≥60 days (44.8% vs 55.3%, P < 0.001) compared with platform initiators. In addition, natalizumab initiators were less likely to switch treatment (13.9% vs 19.1%, P = 0.007) and took longer to switch (400.9 days vs 330.7 days, P < 0.001) compared with platform initiators. Nearly 79% of platform initiators who switched went to another platform therapy. Approximately two thirds of patients who switched to a third DMT (n = 130) switched to another platform therapy. A total of 9% of natalizumab and platform initiators discontinued DMT within the 2 years.

Conclusions

Most MS patients initiating DMT started on platform therapy. Natalizumab initiators tended to stay on index therapy, have fewer treatment gaps, and switch less than platform initiators in the 2 years after treatment initiation. Switching between platform therapies is common despite evidence that MS patients on platform therapy may benefit from switching to natalizumab.     

Differential Micro RNA Expression in PBMC from Multiple Sclerosis Patients

Differences in gene expression patterns have been documented not only in Multiple Sclerosis patients versus healthy controls but also in the relapse of the disease. Recently a new gene expression modulator has been identified: the microRNA or miRNA. The aim of this work is to analyze the possible role of miRNAs in multiple sclerosis, focusing on the relapse stage. We have analyzed the expression patterns of 364 miRNAs in PBMC obtained from multiple sclerosis patients in relapse status, in remission status and healthy controls. The expression patterns of the miRNAs with significantly different expression were validated in an independent set of samples. In order to determine the effect of the miRNAs, the expression of some predicted target genes of these were studied by qPCR. Gene interaction networks were constructed in order to obtain a co-expression and multivariate view of the experimental data. The data analysis and later validation reveal that two miRNAs (hsa-miR-18b and hsa-miR-599) may be relevant at the time of relapse and that another miRNA (hsa-miR-96) may be involved in remission. The genes targeted by hsa-miR-96 are involved in immunological pathways as Interleukin signaling and in other pathways as wnt signaling. This work highlights the importance of miRNA expression in the molecular mechanisms implicated in the disease. Moreover, the proposed involvement of these small molecules in multiple sclerosis opens up a new therapeutic approach to explore and highlight some candidate biomarker targets in MS.     

多发性硬化患者的视觉、脑干听觉诱发电位测定及其意义

目的；探讨视觉诱发电位（VEP）、脑干听觉诱发电位（BAEP）对多发性硬化（MS）的诊断意义。方法：对20例临床诊断为MS的患者进行VEP、BAEP检测，并与对照组进行比较分析。结果：MS患者VEP、BAEP的异常率分别为70％和55％。VEP、BAEP异常者中，各有72％和63％的患者，临床有相应的症状；各有28％和37％的患者临床无相应症状。结论：VEP、BAEP检测对MS的诊断有重要意义。     

视神经脊髓型多发性硬化临床特点19例分析

目的分析视神经脊髓型多发性硬化（OSMS）患者的临床特征。方法收集19例符合Kira诊断标准OSMS患者的临床资料，并结合实验室检查进行分析。结果和结论19例OSMS患者在发病年龄、病程、起病症状、MRI检查、诱发电位、脑脊液寡克隆区带及治疗等方面与国外报道基本一致。但是本研究OSMS患者未见脑脊液淋巴细胞异常增多（pleocytosis），患者脑脊液蛋白亦低于国外报道，OSMS在不同类型MS中构成比例偏低（18．62％）。     

多发性硬化症与可溶性白细胞介素-2受体的关系

目的 探讨多发性硬化症(multiple sclerosis,MS)患者血清中可溶性白细胞介素2受体(sIL-2R)水平的变化及临床意义.方法 将21例 MS患者按病情分为2组,MS急性复发组(n=15例)和MS缓解组(6例).另选健康体检者(n=25)为对照组.采用双抗体夹心ELISA法检测3组血清sIL-2R水平的变化.结果 MS急性复发组和MS缓解组血清中sIL-2R水平均显著高于对照组(均P< 0.01);MS急性复发组sIL-2R 水平高于MS缓解组(P<0.05).重型MS急性复发者SIL-2R水平高于轻型MS急性复发者(P＜0.05).结论 检测sIL-2R 水平的变化可用于评估机体免疫状态和作为MS 患者病情严重程度的标志.     

脑型多发性硬化的磁共振影像学分析

目的:探讨脑型多发性硬化(MS)的临床特点,分析核磁共振检查(MRI)对脑型多发性硬化的诊断价值。方法:搜集脑型多发性硬化患者的MRI结果进行回顾性分析。结果:23例患者入组,脑MRI检查均有阳性发现,以脑室周围及胼胝体最常受累,皮质受累4例(17.4%)。MRI增强见强化病灶者13例(56.5%)。结论:常规MRI对多发性硬化的诊断具有一定的价值,必要时定期复查。     

Frequency of Chronic Headaches in Japanese Patients With Multiple Sclerosis: With Special Reference to Opticospinal and Common Forms of Multiple Sclerosis

Background.— Headache is common in Western patients with multiple sclerosis (MS), but its frequency has not been reported in Asian patients. In Asians, the opticospinal form of MS, showing similar characteristics to relapsing neuromyelitis optica in Westerners, is regarded as a different subtype from conventional MS. Objectives.— The aim of this study was to clarify the frequency of primary and chronic secondary headaches in Japanese patients with MS and the factors associated with the emergence of such headaches. Methods.— We investigated 127 consecutive patients with clinically definite MS. Frequencies of primary and chronic secondary headaches were compared according to clinical subtype, administration of interferon beta, and anti‐aquaporin‐4 antibody status. Results.— The frequency of patients with primary and chronic secondary headaches at the time of interview was 64/127 (50.4%); the frequency of migraine was 26/127 (20.4%) and that of tension‐type headache was 38/127 (29.9%). The frequencies of patients with primary and chronic secondary headaches and migraine without aura after the onset of MS were higher in patients undergoing interferon beta therapy than in those not on the therapy (42.4% vs 23.4%, P < .05 and 15.1% vs 4.3%, P = .05, respectively). There were no significant differences in the frequency of primary and chronic secondary headaches based on clinical subtype of MS. However, among patients not receiving interferon beta, the occurrence of migraine with aura after the onset of MS was significantly higher in patients with anti‐aquaporin‐4 antibody than in patients without the antibody (13.3% vs 0.0%, P < .05). Conclusions.— In Japanese patients with MS, the frequency of primary and chronic secondary headaches, especially migraine, was higher than in the general Japanese population. Administration of interferon beta was related to a higher frequency of primary and chronic secondary headaches, especially migraine without aura, irrespective of clinical subtype of MS.     

Patients With High-disease-activity Relapsing-Remitting Multiple Sclerosis in Real-world Clinical Practice: A Population-based Study in Sweden

PurposeThis study aims to compare the disease progression and disease-modifying treatment–switching patterns between patients with high-disease-activity (HDA) relapsing-remitting multiple sclerosis (RRMS) and patients with low-disease-activity (LDA) RRMS in real-world clinical practice.MethodsThe confirmed disease progression and time to switch of 6647 patients from the Swedish multiple sclerosis registry were analyzed using a marginal structural model that compared patients with relapsing HDA (HDA-R) and lesion HDA (HDA-L) following definitions in European labels of disease-modifying therapies with patients with LDA. Time to milestone and stratified drug cohort analyses were used for internal validation.FindingsA total of 262 patients with LDA, 985 patients with HDA-R, and 683 patients with HDA-L were included in the primary analysis. The HDA-R subgroup had statistically significant greater risk of disease progression (hazard ratio = 1.23; 95% CI, 1.03–1.46) and no difference in time to switch compared with the LDA subgroup. The HDA-L subgroup had statistically significant shorter time to switch (hazard ratio = 1.47; 95% CI, 1.31–1.66) and no difference in disease progression compared with the LDA subgroup.ImplicationsCompared with past research on HDA RRMS grounded mainly in randomized controlled trials of individual disease-modifying therapies, the main contribution of this study is that HDA, as identified by relapses, in real-world clinical settings has a clearer association with disease progression than HDA identified by new magnetic resonance imaging lesions. Taking into account that the HDA-L subgroup had a shorter time to switch, there is evidence of an unmet need for effective treatments in clinical practice for both the HDA-R and HDA-L subgroups.     

Further validation of the Multiple Sclerosis Self-Efficacy Scale

Abstract

Purpose: This study examined the factorial and construct validity of the Multiple Sclerosis Self-Efficacy (MSSE) Scale in two samples of people with multiple sclerosis (MS). Method: Two samples (n's?=?292, 275) of participants with MS were recruited from across the United States. Participants in both studies completed a questionnaire battery that included the MSSE and measures of symptoms, dysfunction, disability, psychosocial aspects, mental/emotional well-being, and quality of life. Factorial validity was tested using confirmatory factor analysis (CFA), whereas construct validity was examined based on bivariate correlations with scores from other measures. Results: The two-factor measurement model provided a poor fit for the 18 items on the MSSE in both the samples. This model provided a good fit for a modified, 10-item scale in both samples. The 10-item version of the MSSE was highly correlated with the original MSSE (r?=?0.97, p?<?0.001) and related constructs (e.g. disability, r?=?0.69, p?<?0.0001). The standardized Cronbach's αs of the two subscales (function and control) of the 10-item version ranged between 0.78 and 0.94 for both samples. Conclusions: Scores from the modified, 10-item version of the MSSE provide a valid and reliable measure of MS-specific self-efficacy among persons with MS.

• Implications for Rehabilitation

• The importance of self-efficacy in managing the consequences of multiple sclerosis (MS) has increased.

• The Multiple Sclerosis Self-Efficacy (MSSE) Scale was developed and validated for measuring self-efficacy in function maintenance and control over MS from patients' perspectives. In the past almost 20 years, this scale has not undergone additional validation of its factor structure and construct validity in large-scale samples of persons with MS.

• The original two-factor construct did not provide a good fit for the 18 items on the MSSE in two independent samples. We modified the MSSE and found the 10 items fitted by the two-factor construct well with one sample and demonstrated cross-validity of the 10 items in the second sample.

• The 10-item version of the MSSE has good reliability and construct validity in both independent samples. Researchers and clinicians should adopt these 10 items when examining MS self-efficacy of patients.