Kissel J T, Burrow K L, Rammohan K W, Mendell J R
Department of Neurology, Ohio State University College of Medicine, Columbus 43210.
Neurology. 1991 May;41(5):667-72. doi: 10.1212/wnl.41.5.667.
A recent double-blind, placebo-controlled trial has shown that prednisone improves strength in patients with Duchenne muscular dystrophy. To determine whether immunosuppressant effects were important in mediating this improvement, we performed immunohistochemical analyses on muscle biopsies obtained at the conclusion of the trial. We studied 33 patients: 12 from the placebo group, nine from the low-dose prednisone group (0.75 mg/kg/d), and 12 from the high-dose group (1.5 mg/kg/d). There was a significant difference in total T cells (CD2+) between the placebo group and both treatment groups. Similarly, the number of CD8+ cytotoxic/suppressor T cells was significantly decreased in both treated groups compared with placebo. The number of muscle fibers focally invaded by lymphocytes was also significantly decreased in the two treated groups compared with controls. There were no differences between the low- and high-dose groups. The numbers of B cells, natural killer cells, CD4+ cells, macrophages, and necrotic muscle fibers were not significantly different in the treated and control groups. This study suggests that prednisone may improve strength in Duchenne muscular dystrophy through primarily immunologic mechanisms involving T lymphocytes.
最近一项双盲、安慰剂对照试验表明，泼尼松可改善杜氏肌营养不良症患者的肌力。为了确定免疫抑制作用在介导这种改善中是否重要，我们在试验结束时对获取的肌肉活检样本进行了免疫组织化学分析。我们研究了33例患者：12例来自安慰剂组，9例来自低剂量泼尼松组（0.75mg/kg/天），12例来自高剂量组（1.5mg/kg/天）。安慰剂组与两个治疗组之间的总T细胞（CD2+）存在显著差异。同样，与安慰剂相比，两个治疗组中CD8+细胞毒性/抑制性T细胞的数量均显著减少。与对照组相比，两个治疗组中淋巴细胞局部浸润的肌纤维数量也显著减少。低剂量组和高剂量组之间没有差异。治疗组和对照组中的B细胞、自然杀伤细胞、CD4+细胞、巨噬细胞和坏死肌纤维数量没有显著差异。这项研究表明，泼尼松可能主要通过涉及T淋巴细胞的免疫机制来改善杜氏肌营养不良症患者的肌力。
