激素冲击对血浆置换治疗吉兰-巴雷综合征疗效的影响:临床疗效对比观察

目的观察合并应用激素冲击治疗对血浆置换(PE)治疗吉兰-巴雷综合征(GBS)患者疗效的影响。方法对发病后2周内入院的GBS患者采用分组对照观察,其中甲基强地松龙(MP)冲击组7例,PE治疗组12例,PE合并MP冲击组11例。治疗4周后比较不同治疗方案对GBS的疗效。结果入院时MP冲击组、PE治疗组和PE合并MP冲击组Hughes评分分别为(3.1±0.7)、(3.4±0.8)和(3.5±1.1),差异无统计学意义(P>0.05)。治疗4周后比较各组评分改善情况结果表明,PE治疗组及PE合并MP冲击组均较MP冲击组病情改善明显(均P<0.05);而PE治疗组和PE合并MP冲击组的病情改善差异均无统计学意义(P>0.05)。另外,PE治疗组和PE合并MP冲击组在治疗4周时Hughes评分进步1分以上的比例分别为91.7%和81.8%,治疗4周后两组患者可独立步行5 m以上的比例分别为9/12例(75%)和9/11例(81.8%),均无统计学意义(P>0.05)。结论PE治疗和PE合并MP冲击对GBS疗效均明显优于单纯MP冲击治疗。至于MP冲击治疗对PE治疗GBS的短期疗效影响,尚有待于扩大样本进一步观察。

Effect of Methylprednisolone Impulsion plus Plasma Exchange for Guillain-Barre Syndrome: a Controlled Open Trial

Objective To observe the therapeutic effect of methylprednisolone(MP) impulse with plasma exchange(PE) on acute inflammatory demyelinating polyneuropathies(AIDP),i.e.,Guillain-Barre syndrome(GBS).Methods Thirty patients with GBS were enrolled within 14 days after onset.Of these,7 patients were treated with MP(500 mg per day,for 3 to 5 days) alone,12 with PE alone,and another 11 with both intravenous MP(500 mg per day,for 3 to 5 days) and PE.The clinical efficacy was evaluated by clinical improvement from baseline by at least one grade on a seven-point scale of motor function 4 weeks after the treatment.Results Muscle strength improved by one grade or more in 81.8%(9 of 11) of patients in the MP plus PE group,91.7%(11 of 12) in PE alone group(P>0.05),but only 28.6%(2 of 7) in MP alone group.Similarly,the percentage of patients,who were able to walk independently,was 81.8% and 75%(P>0.05)respectively in the MP plus PE group and PE alone group(P>0.05).Conclusions The therapeutic efficacy of MP plus PE or PE alone are significantly better than that of MP alone.There is no significant difference between the treatment with MP plus PE and PE alone therapy.The effects of PE or MP plus PE are significantly better than MP alone.The potential importance of combined treatment of MP and PE needs to be further investigated,because of the limited side-effects of MP.