免疫调节疗法治疗重症肌无力临床观察

目的观察应用静脉注射用免疫球蛋白（IVIg）或血浆置换治疗全身型重症肌无力（MG）的临床疗效和安全性。方法对56例病情恶化需IVIg或血浆置换治疗的全身型重症肌无力患者分两组，27例应用IVIg治疗，29例应用血浆置换治疗。在接受治疗后14天、1个月、3个月分别进行疗效评估。结果两组患者治疗前后评分差异均有统计学意义，并且都能很好地耐受，在治疗初期两种方案疗效相差不大，有效率分别为77．8％（21／27）、75．9％（22／29）。好转后都可维持较长时间，但IVIg维持时间稍长于血浆置换。结论重症肌无力患者中IVIg的治疗效果可与血浆置换匹敌。IVIg在3个月后的评估中疗效优于血浆置换。但在病情恶化初期，患者可根据所在医院的医疗条件选择任一种方案。

Clinical observation of immunomodulatory treatments for myasthenia gravis

Objective To observe the efficacy and the security of treating generalized myasthenia gravis（MG） by using intravenous immunoglobulin（IVIg） and plasma exchange（PLEX）. Methods Fifty-six patients with generalized MG were defined as worsening weakness who needed treatment by Wig or PLEX： 27 patients treated with IVIg compared with 29 patients treated with PLEX. The clinical score was used to assess the therapeutic effects after 14 days,one month and three months of treatment. Results Two groups treated by IVIg or PLEX increased the clinical score, and both groups were well-tolerated. IVIg was comparable to PLEX in the efficacy in an early stage, the effective rate was respectively 77.8 % （21/27）, 75.9 % （22/29）, but the final assessment revealed that the therapy effect of IVIg was better than that of PLEX. Conclusion IVIg has comparable efficacy to PLEX in the treatment of generalized MG patients,and IVIg showed a longer duration of improvement than PLEX. Both treatments revealed that the effect is comparable in early period, so either treatment may be offered to the worsening weakness patients to IVIg or PLEX depending on availability of resources.