利妥昔单抗治疗视神经脊髓炎疗效与安全性分析

发布时间：2018-05-09 19:02

本文选题：视神经脊髓炎 + 利妥昔单抗　；参考：《郑州大学》2017年硕士论文

【摘要】：背景:视神经脊髓炎(neuromyelitis optica,NMO)是免疫介导的视神经和脊髓同时或相继受累的急性或亚急性原发性中枢神经系统炎性脱髓鞘疾病[1],早在1870年英国医生Sir Tomas Allbutt就注意到视力丧失可与脊髓疾病合并发生,当时发现在5例急性脊髓炎的病员中,1例有眼部症状。1894年Devic和他的学生Gault复习了既往文献报道中的16例病例和他们收治的2例双眼失明患者,在其前后数日或数周伴发横贯性或上升性脊髓炎,后被称为Devic病。视神经脊髓炎在非白种人如日本、中国等亚洲人群多见[2],在白种人如欧美等西方国家人群中少见。视神经脊髓炎的症状较多发性硬化严重,复发率高于多发性硬化,且复发型患者预后较差,5年内约半数患者出现单眼视力严重下降甚至失明,70%发生严重瘫痪,加重家庭和社会负担。因此寻找有效的治疗药物改善症状,并减少复发,具有重大现实意义。近年来国内外相关研究表明,利妥昔单抗(RTX)治疗NMO能有效改善症状、减少复发、延缓残疾的进展。目的:探讨利妥昔单抗对视神经脊髓炎患者的治疗效果,并分析其安全性。方法:视神经脊髓炎患者共62例,随机分成两组,研究组23例、对照组39例,所有入选者均签署知情同意书。对照组给予激素冲击治疗,缓解期给予环磷酰胺静脉滴注;研究组在急性期激素冲击治疗的基础上,缓解期给予利妥昔单抗治疗。2组患者分别在治疗前及治疗9周后进行EDSS部分子项目评分包括锥体系功能、大脑功能、脑干功能、视觉或视神经功能、感觉功能、膀胱直肠功能;并进行中国视力表检查、日常生活活动能力评定。并观察利妥昔单抗治疗后的不良反应。在治疗后随访患者2年,了解有无复发。结果:治疗9周后,研究组的视力、日常生活活动能力明显提高,优于对照组(P0.05)。研究组EDSS部分子项目评分变化优于对照组,功能恢复明显优于对照组(P0.05)。研究组用药后未出现严重不良反应,首次用药时有轻度不良反应,在后三次用药时不良反应未再出现。随访2年后发现,研究组复发率明显低于对照组。结论:利妥昔单抗联合激素冲击治疗视神经脊髓炎效果显著,明显改善患者视力及神经功能,降低致残率,提高日常生活能力。治疗过程安全有效。同时能显著降低复发率。
[Abstract]:Background: neuromyelitis (NMOO) is an acute or subacute primary central nervous system inflammatory demyelinating disease involving the optic nerve and spinal cord simultaneously or sequentially [1]. As early as 1870, Sir Tomas Allbutt, a British doctor, noticed the vision. Loss of strength can be associated with spinal cord disease, One of the five patients with acute myelitis was found to have ocular symptoms. In 1894, Devic and his student Gault reviewed 16 previously reported cases and 2 binocular blindness patients they treated. Transversal or ascending myelitis occurs days or weeks before and after it is called Devic's disease. Optic neuromyelitis is more common in non-white people such as Japan and China than in white people such as Europe and America. The symptom of optic neuromyelitis was more serious than that of multiple sclerosis, the recurrence rate was higher than that of multiple sclerosis, and the prognosis of recurrent patients was poor. Increase the burden on families and society. Therefore, it is of great practical significance to find effective drugs to improve symptoms and reduce recurrence. Recent studies at home and abroad have shown that Rituximab can effectively improve symptoms, reduce recurrence and delay the progress of disability in the treatment of NMO. Objective: to evaluate the efficacy and safety of rituximab in the treatment of optic neuromyelitis. Methods: a total of 62 patients with optic neuromyelitis were randomly divided into two groups: study group (n = 23) and control group (n = 39). The control group was treated with hormone shock and cyclophosphamide was given intravenously in the remission period; the study group was treated with hormone shock therapy in the acute phase. The patients in group 2 were given Rituximab in the remission period before and 9 weeks after treatment. The scores of EDSS subitems included pyramidal function, brain function, brainstem function, visual or optic nerve function, sensory function, bladder and rectum function. And the Chinese visual acuity chart examination, daily life activity ability evaluation. The adverse effects of rituximab were observed. The patients were followed up for 2 years to see if there was recurrence. Results: after 9 weeks of treatment, the visual acuity and activity of daily living in the study group were significantly improved, which was better than that in the control group (P 0.05). The scores of EDSS subitems in the study group were better than those in the control group, and the functional recovery was significantly better than that in the control group (P 0.05). In the study group, there were no serious adverse reactions, mild adverse reactions at the first time, and no adverse reactions at the last three times. After 2 years follow-up, the recurrence rate in the study group was significantly lower than that in the control group. Conclusion: Rituximab combined with hormone shock therapy is effective in the treatment of optic neuromyelitis, which can obviously improve the visual acuity and nerve function, reduce the rate of disability and improve the ability of daily living. The treatment process is safe and effective. At the same time, the recurrence rate was significantly reduced.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.52

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