大剂量甲泼尼龙与免疫球蛋白治疗多发性硬化急性期的疗效观察

目的 评价大剂量甲泼尼龙和免疫球蛋白冲击治疗急性期多发性硬化(MS)的临床疗效.方法 对2002～2007年分别采用大剂量甲泼尼龙、免疫球蛋白以及两者联合冲击治疗67例复发一缓解型急性期MS患者进行回顾性分析.按主要的治疗方法分为甲泼尼龙(MPS)组、免疫球蛋白(IG)组及甲泼尼龙加免疫球蛋白(MPS IG)组,以治疗前后3组患者Kurtzke神经功能障碍量表(EDSS)平均评分的变化反映疗效,比较以上3种治疗急性期MS的疗法的疗效.结果 治疗7d时有效率MPS组为69.2%.IG组为85%,MPS IG组为85.7%,IG组和MPS IG组明显高于MPS组(P均＜0.05);治疗30d时有效率Mrs组为96.1%,IG组为100%,MPS IG组为95.2%.3组之间有效率无统计学差异(P＞0.05).IG组和MPS IG组住院治疗后第7d时EDSS评分降低明显(P＜0.01).且优于MPS组(P均＜0.05);治疗30d时3组治疗前后比较有非常显著的差异(P均＜0.01),MPS IG组与IG组、MPs组比较EDSS评分无明显差异(P＞0.05).结论 大剂量甲泼尼龙和免疫球蛋白均对急性期复发一缓解型MS有效.其中免疫球蛋白能较快起效,但二者合用并没有比单用表现出更好的疗效.

Effect of high dose of methylprednisolone and immunogiobulin in the treatment of patients with multiple sclerosis in acute phase

Objective To evaluate the therapeutic efficacy of multiple sclerosis(MS) in acute phase,by high doses of methylprednisolone and immunoglobulin.Methods To analyze retrospectively the therapeutic efficacy of 67 cases of relapse-remitting MS with high dose of methylprednisolone and immunoglobulin.All of these cases were divided into three groups as immunoglobulin group(IG),methylprednisolone group(MPS) and methylprednisolone associated with immunoglobulin group(MPS IG),The therapeutic efficacy of the three ways were compared by the scores of Kurtzke expanded disability status scale(EDSS) before and after therapy.Results The effectiveness of MPS,IG and MPS IG groups were 69.2%,85.0% and 85.7% after 7 days respectively,and the effectiveness of IG and MPS IG groups were higher than MPS group(P<0.05 with each).After 30 days,the effectiveness was 96.1%,100% and 95.2% in three groups respectively,but there were no difference between them(P>0.05 with each).The scores of EDSS in IG and MPS IG groups were increased greatly after 7 days(P <0.01 with each),and superior to the MPS group(P<0.05 with each).The scores of EDSS of MPS,IG and MPS IG groups were even much lower after 30 days(P <0.01),but there were no difference between three groups(P>0.05).Conclusion High dose of methylprednisolone and immunoglobulin are all effective to relapse-remitting MS in acute phase,but the later is faster.The effect of methylprednisolone associated with immunoglobulin is the same as methylprednisolone or immunoglobulin alone.