Qiu Wei, Kermode Allan G, Li Rui, Dai Yongqiang, Wang Yuge, Wang Jingqi, Zhong Xiaonan, Li Caixia, Lu Zhengqi, Hu Xueqiang
Department of Neurology, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong 510630, China.
Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, WA, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia.
J Clin Neurosci. 2015 Jul;22(7):1178-82. doi: 10.1016/j.jocn.2015.01.028. Epub 2015 May 23.
We investigated the efficacy of azathioprine (AZA) plus long-term low dose corticosteroids in Chinese patients with neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD) at the Center for Demyelinating Diseases, South China. We prospectively enrolled patients between June 2010 and June 2014. Annualized relapse rate (ARR), expanded disability status scale (EDSS) score and modified Rankin Scale (mRS) were analyzed retrospectively. Of 77 patients with NMO/NMOSD (four males, 73 females; age range: 4-69 years), median disease duration before initiation of AZA was 32.0 months (range: 2.0-197.0). Median post-treatment follow-up was 23 months (range: 6-58) and 44 patients (57.1%) were relapse-free at median follow-up 19 months (range: 6-51). Pre-treatment ARR was 0.923, and post-treatment ARR was 0 (p < 0.0001). Survival analysis indicated a significantly lower risk of relapse (hazard ratio 0.522; 95% confidence interval 0.377-0.722; p < 0.0001). Significant improvements were shown in the EDSS (3.0 versus 1.0; p < 0.0001) and mRS (2.0 versus 1.0; p < 0.0001). Our study provides evidence supporting the use of AZA plus a low dose corticosteroid as an effective and safe strategy which is associated with a reduction in the risk of relapse in Chinese patients with NMO.
我们在中国南方脱髓鞘疾病中心研究了硫唑嘌呤（AZA）联合长期低剂量皮质类固醇对中国视神经脊髓炎（NMO）和视神经脊髓炎谱系障碍（NMOSD）患者的疗效。我们前瞻性地纳入了2010年6月至2014年6月期间的患者。对年化复发率（ARR）、扩展残疾状态量表（EDSS）评分和改良Rankin量表（mRS）进行了回顾性分析。在77例NMO/NMOSD患者中（4例男性，73例女性；年龄范围：4 - 69岁），开始使用AZA前的疾病中位病程为32.0个月（范围：2.0 - 197.0）。治疗后的中位随访时间为23个月（范围：6 - 58），44例患者（57.1%）在中位随访19个月（范围：6 - 51）时无复发。治疗前ARR为0.923，治疗后ARR为0（p < 0.0001）。生存分析表明复发风险显著降低（风险比0.522；95%置信区间0.377 - 0.722；p < 0.0001）。EDSS（3.0对1.0；p < 0.0001）和mRS（2.0对1.0；p < 0.0001）有显著改善。我们的研究提供了证据，支持使用AZA联合低剂量皮质类固醇作为一种有效且安全的策略，该策略与降低中国NMO患者的复发风险相关。
