摘要
目的评价免疫抑制治疗老年重症肌无力(myasthenia gravis,MG)患者的远期疗效.方法回顾性评价随访时间≥12个月的99例老年MG患者(发病年龄≥60岁)的临床疗效,其中完全缓解、药物缓解和显著改善均属于远期疗效良好.结果免疫抑制治疗对老年MG的总有效率为79.8%(79/99).糖皮质激素(glucocorticoids,GC)对老年MG的总有效率为72.9%(35/48),其中完全缓解者8例,缓解期18～67个月,平均(54.8±19.8)个月;药物缓解者16例,缓解期7～37个月,平均(15.7±8.0)个月.GC对男性MG患者的有效率为83.3%(25/30),对女性MG患者的有效率仅为55.6%(10/18),两者相比,差异具有统计学意义(P＜0.05).GC联合环磷酰胺(CTX)治疗对老年MG的总有效率达86.3%(44/51),其中完全缓解者11例,缓解期17～90个月,平均(50.3±25.4)个月;药物缓解者19例,缓解期7～56个月,平均(25.5±15.9)个月.联合治疗对老年男性MG患者有效率为88.5%(23/26),对女性MG患者的有效率为84.0%(21/25),两者相比差异无统计学意义.然而,联合治疗与激素治疗相比,不仅能够显著延长老年MG患者药物缓解期的持续时间(P＜0.05),而且能够明显提高老年女性MG的远期有效率(P＜0.05).结论免疫抑制剂的应用是治疗老年MG的重要措施.GC对老年MG 的治疗效果存在性别差异,对男性的效果优于女性.GC联合CTX治疗能够延长老年MG患者的药物缓解时间,能够显著提高老年女性MG患者的远期有效率.
Objective To evaluate the long-term outcomes of immunosuppressive agents used for myasthenia gravis(MG) patients with disease onset after or at 60. Methods Long-term outcome was evaluated in 99 cases with following-up longer than 1 year. Remission, pharmacological remission, and marked improvement were considered as good results or good long-term outcome. Results All good results were recorded in 79 MG patients (79.8%) receiving immunosuppressive treatments. 48 patients had been treated with glucocorticoids (GC) alone, of them, 35(72.9%) achieved good results. 8 of them having a complete remission for 18 to 67 months (averaging (54.8±19.8) months). 16 patients got pharmacological remission for 7 to 37 months (averaging (15.7±8.0) months). MG patients in different gender had different responses to GC. The good long-term outcome was found in 83.3% (25/30) males and only 55.6% (10/18) in females with GC therapy. There was a rate statistically higher in male than in female patients (P<0.05). On contrast to GC therapy, there were 51 MG patients in the elderly had received a combined therapy of GC and cytoxan (CTX). 44 MG patients (86.3%) gained good results. 12 of them got a complete remission for 17 to 90 months (averaging (50.3±25.4) months), 20 of them received pharmacological remission for 7 to 56 months (averaging (25.5±15.9) months). The combined therapy had no different effects shown in MG patients in different gender, statistically. 23 (88.5%) male and 21 (84.0%) female patients obtained good results. However, When compared with GC therapy and the combined therapy, more benefits were easily found in patients with combined therapy. Combined therapy might not only prolong the time of pharmacological remission in overall MG patients(P<0.05) but also increase the long-term effects in female MG patients (P<0.05). Conclusions Immunosuppressive treatments should be still an important therapeutic measure in the aged MG patients. The male MG patients might have better responses to GC therapy than the female. The combined therapy might resulted in a pharmacological remission longer in patients studied, and a long-term effect increased in female patients.
出处
《中华神经科杂志》
CAS
CSCD
北大核心
2005年第6期393-396,共4页
Chinese Journal of Neurology
