针对重症肌无力的早期积极治疗策略。

Early aggressive treatment strategy against myasthenia gravis.

机构信息

Department of Neurology, Hanamaki General Hospital, 4-28 Kajoh-chou, Hanamaki, Japan.

出版信息

Eur Neurol. 2011;65(1):16-22. doi: 10.1159/000322497. Epub 2010 Nov 30.

Abstract

BACKGROUND/AIMS: In treating myasthenia gravis (MG), our aims were to achieve early minimal manifestations (MM) by performing early aggressive therapy (EAT) using plasmapheresis and high-dose intravenous methylprednisolone, and then to maintain the status with low-dose oral corticosteroids (EAT strategy). We examined the merits of the EAT strategy.

METHODS

We retrospectively analyzed long-term effects of the EAT strategy (duration of therapy: 4.1 years) for 49 de novo MG patients and compared the effects to those of high-dose oral prednisolone therapy for 22 patients.

RESULTS

The EAT group achieved marked early improvement with much lower doses of oral prednisolone compared to the high-dose prednisolone group. The patients who achieved MM with prednisolone ≤5 mg/day were more frequent in the EAT group at both 1 year (57.1 vs. 4.5%) and final observation (77.6 vs. 27.3%). Both new-onset diabetes and patients who had complained of moon face were less frequent in the EAT group. However, in the EAT group, due to a temporary inability to maintain MM, additional short-term hospitalizations to return to MM by EAT were required.

CONCLUSIONS

The EAT strategy has advantages of early improvement with less frequent steroid-related complications. The labor and cost required are evident disadvantages.

摘要

背景/目的：在治疗重症肌无力 (MG) 时，我们的目标是通过使用血浆置换和大剂量静脉甲基强的松龙进行早期积极治疗 (EAT) 来尽早实现最小疾病表现 (MM)，然后用低剂量口服皮质类固醇维持病情稳定（EAT 策略）。我们检验了 EAT 策略的优点。

方法

我们回顾性分析了 49 例新诊断的 MG 患者采用 EAT 策略（治疗持续时间：4.1 年）的长期效果，并将其与 22 例患者采用大剂量口服泼尼松龙治疗的效果进行了比较。

结果

EAT 组患者在接受较低剂量的口服泼尼松龙治疗后，早期改善明显，效果优于大剂量泼尼松龙组。在 1 年（57.1% vs. 4.5%）和最终观察（77.6% vs. 27.3%）时，EAT 组达到 MM 且泼尼松龙用量≤5mg/日的患者更为常见。EAT 组中发生新发糖尿病和有满月脸抱怨的患者较少。然而，EAT 组由于暂时无法维持 MM，需要额外进行短期住院治疗以恢复 EAT 后的 MM。