大剂量丙球蛋白抢救重症肌无力危象的临床研究

目的:探讨大剂量丙球蛋白(Ig)在抢救重症肌无力危象的临床疗效。方法:根据Qsseman分型,Ⅱa型2例、Ⅱb型8例、Ⅲ型13例、Ⅳ型3例MG危象患者在综合抢救的同时联合应用大剂量Ig静脉注射为治疗组。Ⅱa型1例、Ⅱb型6例、Ⅲ型15例、Ⅳ型2例综合治疗患者为对照组。以临床绝对评分及临床相对评分作为治疗前、后疗效判定标准,于治疗前、后2周抽清晨空腹血查AChRAb,观察治疗前、后重症肌无力的免疫状态的变化。结果:治疗组治疗前、后AChRAb有明显差异(P<0.01)。对照组治疗前、后无明显差异。临床评分两组治疗前、后均有明显差异(P<0.05),但治疗组治疗前、后分值差明显大于对照组(P<0.01)。经治疗后两组危象持续时间及有效率有明显差异(P<0.01)。结论:大剂量Ig在抢救MG危象中疗效明显、安全、可靠,值得临床应用。

High Dose Intravenous Injection of Gamma-globulin in Patients with Myasthenia Gravis Crisis

Aim:To observe the immune state of myasthenia gravis(MG) crisis before and after treatment with high dose intravenous injection of gamma-globulin (HDIV Ig)and to study clinical effect of HDIVIg.Methods:Treatment group composed of 26 MG crisis patients were rescued with synthesis treatment and HDIV Ig at the same time,while 24 MG crisis patients were rescued only with synthesis treatment as the control group. The changes of acetylchdine receptor antibody (AChRAb) in 50 MG patients before and after treatment were studied with Enzyme-linked Immunosorbent Assay (ELISA). The clinical absolute grade point and clinical opposite grade point were used as the curative effect judge standard. Results:In the treatment group (n=26),the level of AChRAb of patients were significantly lower after HDIV Ig,P<0.05,while it was not significant in the control group (n=24),P>0.05. The clinical grade points of the two groups have obvious difference P<0.05 before and after treatment,but the difference of the treatment group is obviously higher than the control group P<0.05.After treatment the two groups both have obvious difference on the duration and effective rate of the MG crisis.Conclusion:The clinical effect of HDIV Ig is significant,and it is safe,reliable and deserving clinical practice.