A型肉毒毒素治疗偏侧面肌痉挛临床分析

目的观察国产及进口A型肉毒毒素(BTX-A)治疗偏侧面肌痉挛(HFS)的临床效果。方法总结2013年5月至2015年11月就诊于我院门诊的215例HFS患者及39例接受BTX-A治疗HFS患者的临床特点,包括性别、面部受累部位、病情程度、发病年龄及病程等特点;比较注射保妥适32例次和衡力20例次的肉毒素用量、治疗效果、疗效持续时间及不良反应,总结重复注射及药物互换时的疗效,总结注射部位与常规注射部位的变化。结果 215例HFS中,女性154例,占71.63%;面部受累左侧略占优势;平均发病年龄45岁,平均病程24个月;病情程度中及重度169例。在接受BTX-A治疗的39例中,女性、受累左侧面部和病情程度重居多,重复治疗7例,共注射52例次。保妥适组和衡力组间肉毒素用量比较差异无统计学意义(P=0.087),治疗效果亦无显著差异(P=1.000),治疗平均有效时间组间差异无统计学意义(P=0.309),不良反应无明显差异(P=0.849)。重复注射及药物互换时无疗效减退。根据痉挛肌肉受累部位不同,注射部位在常规部位上增加了耳后镫骨肌和颈部颈阔肌。结论局部注射国产和进口BTX-A治疗HFS同样疗效显著,毒副作用少、安全性高,可重复使用。并且重复注射时,进口和国产BTX-A可以互换,注射部位增加了镫骨肌和颈阔肌,能更好改善痉挛肌肉群症状。

Clinical analysis of efficacy of the botulinum toxin-A in the treatment of hemifacial spasm

Objective To observe the clinical effects of Chinese and imported botulinum toxin-A ( BTX-A) on hemifacial spasm( HFS). Methods To summarize the clinical features of 215 HFS cases and those of 39 HFS ca-ses that receiving BTX-A treatment from May 2013 to November 2015 in our hospital. The main contents included gen-der,facial affected area,severity,onset age,duration and other characteristics. In addition,compare the dose of botuli-num toxin,the treatment effect,the effective lastting time,and adverse reactions between 32 person-times with Botox treatment and 20 person-times with Chinese BTX-A treatment. We also summarized the efficacy of repeated injection and drug exchange,and analyzed the changes between the injection site and conventional injection site. Results In 215 HFS cases,female 154,the ratio of women was 71. 63%;the left side facial affected area was slightly dominant;the av-erage onset age was 45 years,and the average duration was 24 months;the degree of moderate and severe was 169 ca-ses. Women,left side facial affected and the severe case accounted for most in 39 cases with BTX-A treatment. Seven patients chose repeated injection,and all patients accepted 52 times of injection. There was no significant difference in the dose of botulinum toxin(P=0. 087);between the Botox group and Chinese BTX-A group,there was no significant difference in the treatment effect(P=1. 000),the average effective time(P=0. 309),and in adverse reactions(P=0. 849). The treatment effect was not diminishing during repeated injections and drug exchange. According to the differ-ent affected spasm muscle,the stapedius and platysma were used as new injection sites based on conventional sites. Conclusion Local injection of Chinese and imported BTX-A in HFS patients both had obvious therapeutic effect,less toxicity and high safety and is reusable. Furthermore,Chinese and imported BTX-A can be used interchangeably during repeated injections. Stapedius and platysma as new injection sites can better improve symptoms of spastic muscles.