多发性硬化患者急性期行血浆置换治疗的疗效分析

发布时间：2018-06-15 17:15

本文选题：多发性硬化 + 血浆置换　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:多发性硬化(multiple sclerosis,MS)是一种以中枢神经系统(central nervous system,CNS)脱髓鞘病变为特点的自身免疫性疾病,临床特点主要体现为异常病变在空间上多发性以及病情进展上的时间多发性。截止目前尚未发现治愈MS的有效方法。采用的治疗方案一般为激素冲击治疗、血浆置换或两者联合治疗。已在国内外相关领域得到认可的首选药物治疗为糖皮质激素冲击治疗。我们在实际工作中会发现有不少急性期MS患者,即使确诊后立即给予糖皮质激素冲击治疗,但效果效果并不理想。接下来该如何选择治疗?我们设想,在治疗早期联合血浆置换治疗是否能够改善患者预后呢?本研究设计单独应用糖皮质激素与血浆置换联合糖皮质激素对MS患者治疗效果的比较,以提供临床治疗的依据。方法:本研究入组了2012年9月至2016年1月入住我院神经内科的MS患者,并且均为在急性治疗初期对糖皮质激素冲击治疗不敏感的患者。入组标准:依据2010年中国MS诊断和治疗专家共识,纳入符合相关诊断标准的复发缓解型患者。激素冲击治疗不敏感定义:甲强龙静脉滴注1.0g×5d后立即给予EDSS评分,显示EDSS评分改善0.5分即为效果较差患者。入组病例数共计28例,其中男8例,女20例;年龄16-66岁,平均41.50±12.72岁;平均病程1.3年;平均急性期发病时间4.8d。所有入组研究对象被分为观察组与对照组各14例。其中,14例对照组的患者给予静脉注甲泼尼松龙,逐渐减量至口服甲泼尼松龙片;14例观察组的患者,给予甲泼尼松龙静脉滴注后联合血浆置换治疗。治疗后,将两组的临床效果(EDSS评分)进行对比。观察指标有:(1)激素改为口服(大约17天)时神经功能障碍量表(EDSS)评分的改善情况,同时以显效、有效和迟效作为判断临床疗效的标准之一,总有效率(%)=(显效+有效)/总例数×100%;(2)对照两组患者3月后神经功能障碍量表(EDSS)评分改善情况及复发(出现新的临床症状主述为标准);(3)对照两组患者治疗期间各种不良反应的发生率。全部数据分析利用统计软件SPSS17.0进行处理,各组连续性变量数据以x±s形式呈现,组间差异比较采用t检验,计数资料使用χ2检验,以P0.05代表差异具有统计学意义。结果:经过治疗后两组病人比较,(1)有效率方面,观察组的总有效率为92.9%,对照组的总有效率57.1%,观察组的治愈率显著高于对照组,差异具有统计学意义(P0.05);(2)观察组治疗后的EDSS评分下降和对照组相比,有显著变化,有统计学意义(P0.05);(3)两组患者3月后神经功能障碍量表(EDSS)评分改善情况有统计学意义(P0.05)及但临床复发次数,无统计学意义(P0.05)(4)两组患者的轻微不良反应比较,结果无统计学意义(P0.05)。结论:经过本研究得出,急性期对糖皮质激素冲击治疗不敏感的MS患者联合血浆置换治疗是安全、有效的。
[Abstract]:Objective: multiple sclerosis (MS) is an autoimmune disease characterized by demyelinating lesions of central nervous system (CNS). Up to now, no effective method has been found to cure MS. Hormone shock therapy, plasma exchange or a combination of both are commonly used. Glucocorticoid shock therapy has been recognized as the preferred drug therapy in related fields at home and abroad. We find that there are many MS patients in acute stage, even if they are given glucocorticoid impulse therapy immediately after diagnosis, but the effect is not satisfactory. How do you choose treatment next? We imagine that the combination of plasma-exchange therapy at the early stage of treatment can improve the prognosis of patients. The purpose of this study was to compare the efficacy of glucocorticoid and plasma exchange combined with glucocorticoid in the treatment of MS patients. Methods: MS patients admitted to our hospital from September 2012 to January 2016 were all insensitive to glucocorticoid shock therapy at the early stage of acute treatment. Admission criteria: according to the consensus of Chinese MS diagnosis and treatment experts in 2010, to include relapsed remission patients in accordance with relevant diagnostic criteria. The definition of insensitivity to hormone shock therapy: the EDSS score was given immediately after intravenous drip of 1.0 g 脳 5 d, which showed that 0.5 score of EDSS score was poor. A total of 28 cases were included, including 8 males and 20 females, aged 16-66 years (mean 41.50 卤12.72 years), mean course of disease 1.3 years, mean onset time of acute stage 4.8 days. All the subjects were divided into observation group (n = 14) and control group (n = 14). Among them, 14 patients in the control group were treated with prednisolone intravenously, and gradually reduced to 14 patients in the observation group who were given meprednisolone intravenously and treated with plasma exchange after intravenous drip of methylprednisolone. After treatment, the clinical effects of the two groups were compared with EDSS scores. The observation measures include: 1) the improvement of EDSS score when the hormone changed to oral (about 17 days), and one of the criteria for judging the clinical curative effect was obvious effect, effective effect and late effect. Total effective rate (effective / total number of cases 脳 100) the improvement and recurrence of EDSSs in the two groups after 3 months of treatment (the new clinical symptoms are mainly described as the standard) the two groups of patients in the control group during the treatment of a variety of not The incidence of good reactions. All data analysis was processed by SPSS 17.0. The data of continuous variables in each group were presented in the form of x 卤s. T test was used to compare the difference among groups, 蠂 2 test was used to count the data, and P0.05 was used to represent the difference. Results: after treatment, the total effective rate was 92.9 in the observation group and 57.1 in the control group. The cure rate of the observation group was significantly higher than that of the control group. The difference was statistically significant (P 0.05) the EDSS scores in the observation group decreased significantly compared with those in the control group. The improvement of EDSS score in the two groups after 3 months was statistically significant (P0.05), but the number of clinical recurrence was not statistically significant (P0.05 / 4). The results showed that there was no significant difference between the two groups in the slight adverse reactions (P 0.05). Conclusion: it is safe and effective to combine plasma exchange therapy with glucocorticoid shock therapy in MS patients in acute phase.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.51

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