激素联合免疫球蛋白治疗慢性炎症性脱髓鞘性多发性神经根神经病的临床研究

发布时间：2018-08-22 10:57

【摘要】：一．目的慢性炎症性脱髓鞘性多发性神经根神经病（chronic inflammatorydemyelinating polyradiculoneuropathy, CIDP）是一类由免疫介导的运动感觉周围神经病，其病程呈慢性进展或缓解复发，多伴有脑脊液蛋白-细胞分离，电生理表现为周围神经传导速度减慢、传导阻滞及异常波形离散；病理显示有髓纤维多灶性脱髓鞘、神经内膜水肿、炎细胞浸润等特点。目前对CIDP有效的治疗方法包括激素、血浆置换(PE)、大剂量静脉用人血免疫球蛋白(IVIg)及免疫抑制剂(IS)等，其中激素是目前治疗的首选药物，但在CIDP的治疗效果、神经功能恢复及复发率等方面还是有许多问题亟待解决，同时长期使用激素所产生的副作用逐渐引起了学者的重视。本研究拟对: IVIg联合糖皮质激素与单独应用糖皮质激素对CIDP的治疗效果对比，以供临床参考。二．方法以2008年2月-2013年2月我院收治的CIDP患者68例为研究对象，将该组研究对象随机分为对照组与观察组各34例，对照组的34例患者进行静脉注射注射用甲泼尼松龙，口服泼尼松，观察组的34例患者在对照组治疗基础上，还静脉注射免疫球蛋白。治疗后，比较两组的临床疗效。观察指标有：①比较两组四肢肌力指标：判断肢体运动功能采用上下肢运动肌力评分Lovett6级分级法来进行评价；②比较生活能力指标：生活能力采用改良Barthel指数评价；③神经功能指标：神经功能采用ASIA神经功能评分表来评价；④比较两组临床症状的恢复时间：包括四肢疼痛、感觉障碍消失的时间，腱反射、四肢肌力和肌张力恢复的时间；⑤比较两组治疗期间发生的不良反应：评价标准为两组患者治疗期间均进行血常规、肝肾功能、心电图等检查，同时记录治疗期间发生不良反应的例数、种类和程度。其中判断临床疗效以显效、有效和迟效为标准，总有效率（%）=（显效+有效）/总例数×100%。统计学处理所有数据采用SPSS16.0统计软件进行分析，各组数据以（x±s））表示，统计分析组间差异用t检验，技术资料的检验使用χ2检验，以P 0.05代表具有统计学意义。三．结果两组治疗后，①观察组的治疗总有效率为97.1%，对照组的治疗总有效率为82.4%。两组的数据差异具有统计学的意义，观察组治愈有效率明显高于对照组，有统计学意义（P 0.05）。②两组治疗前后的四肢肌力、生活能力以及神经功能比较，治疗前均无统计学意义（P0.05），治疗后观察组和对照组与治疗前相比，，都有显著变化，有统计学意义（P 0.05），且观察组的四肢肌力评分、生活能力评分均显著高于对照组，神经功能评分显著低于对照组，有统计学意义（P0.05）。③观察组的四肢肌力、感觉障碍、腱反射等临床症状指标恢复的时间显著短于对照组，有统计学意义（P0.05）。④两组患者均无严重不良反应出现，比较无统计学意义（P0.05）。四．结论相比单用糖皮质激素治疗CIDP，糖皮质激素联合免疫球蛋白应用能增强治疗效果，迅速改善患者的症状，帮助患者恢复肌力、生活能力和神经功能，在临床值得应用。
[Abstract]:I. purpose
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a kind of immune-mediated motor-sensory peripheral neuropathy with a course of chronic progression or remission of recurrence, accompanied by protein-cell separation in cerebrospinal fluid (CSF), and electrophysiological manifestations of peripheral nerve conduction velocity slowing down. Currently, the effective treatments for CIDP include hormones, plasma exchange (PE), high dose intravenous human immunoglobulin (IVIg) and immunosuppressive agents (IS), among which hormones are the first choice. However, there are still many problems to be solved in the treatment of CIDP, the recovery of nerve function and the recurrence rate. At the same time, the side effects of long-term use of hormones have gradually attracted the attention of scholars.
Two. Method
Sixty-eight patients with CIDP admitted to our hospital from February 2008 to February 2013 were randomly divided into the control group and the observation group. 34 patients in the control group were given methylprednisolone for intravenous injection and oral prednisone. 34 patients in the observation group were given immunoglobulin intravenously on the basis of the treatment of the control group. After treatment, the clinical effects of the two groups were compared. The following indexes were observed: (1) Comparing the limb muscle strength indexes of the two groups: judging the limb motor function by Lovett 6 grading method; Comparing the living ability indexes: the living ability was evaluated by modified Barthel index; and (3) Neurological function indexes: Neurological function index; The recovery time of clinical symptoms of the two groups were compared, including limb pain, the time of disappearance of sensory disturbance, tendon reflex, limb muscle strength and muscle tension recovery time; _Comparing the adverse reactions occurred during the treatment of the two groups: evaluation criteria were blood routine, liver during treatment in both groups. Kidney function, electrocardiogram, etc. were examined, and the number, type and degree of adverse reactions were recorded. The clinical efficacy was judged by the criteria of marked, effective and delayed effect. The total effective rate (%)= (marked + effective) / the total number of cases (%) was 100%. All data were analyzed by SPSS16.0 statistical software, and the data of each group were expressed by (+) s). Statistical analysis of the differences between groups using t test, the test of technical data using_2 test, P 0.05 on behalf of statistical significance.
Three. Results
After treatment, the total effective rate was 97.1% in the observation group and 82.4% in the control group. The difference between the two groups was statistically significant. The cure effective rate of the observation group was significantly higher than that of the control group, with statistical significance (P 0.05). The muscle strength, life ability and nerve function of the extremities before and after treatment were compared between the two groups. There was no statistical significance (P 0.05). After treatment, the observation group and the control group had significant changes compared with before treatment, with statistical significance (P 0.05), and the observation group limb muscle strength score, ability to live score were significantly higher than the control group, nerve function score was significantly lower than the control group, with statistical significance (P 0.05). 3 The observation group limb muscle strength, feeling. The recovery time of clinical symptoms such as sensory disturbance and tendon reflex was significantly shorter than that of the control group (P 0.05). There was no significant difference between the two groups (P 0.05).
Four. Conclusion
Compared with glucocorticoid alone in the treatment of CIDP, glucocorticoid combined with immunoglobulin can enhance the therapeutic effect, rapidly improve the symptoms of patients, help patients to restore muscle strength, viability and nerve function, which is worthy of clinical application.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R745.4

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