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目的评价免疫抑制治疗老年重症肌无力(myastheniagravis,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 efficacy of immunosuppressive therapy in patients with myasthenia gravis (MG). Methods The clinical efficacy of 99 elderly MG patients (age ≥60 years) with a follow-up of 12 months or more was retrospectively evaluated. Among them, complete remission, drug remission and significant improvement were both good long-term outcomes. Results The total effective rate of immunosuppressive therapy on elderly MG was 79.8% (79/99). The total effective rate of glucocorticoids (GC) to aged MG was 72.9% (35/48), including 8 cases of complete remission, 18 to 67 months of remission, and an average of 54.8 ± 19.8 ) Months; drug-remission in 16 cases, the remission of 7 to 37 months, an average of (15.7 ± 8.0) months. The effective rate of GC in male patients with MG was 83.3% (25/30), while that of female patients with MG was only 55.6% (10/18), the difference was statistically significant (P <0 · 05). GC combined with cyclophosphamide (CTX) treatment of elderly patients with MG, the total effective rate was 86.3% (44/51), including 11 cases of complete remission, remission of 17 to 90 months, the average (50.3 ± 25 · 4) months; drug-relief in 19 cases, the remission of 7 to 56 months, an average of (25.5 ± 15.9) months. The combined treatment of elderly patients with MG was 88.5% (23/26), female patients with MG was 84.0% (21/25), the difference was not statistically significant. However, compared with hormone therapy, combination therapy can not only significantly prolong the duration of drug remission in elderly MG patients (P <0.05), but also significantly improve the long-term efficiency of MG in elderly women (P <0.05) . Conclusion The application of immunosuppressive agents is an important measure to treat elderly patients with MG. GC treatment of elderly patients with gender differences in MG, the effect is better than men in women. GC combined with CTX treatment can prolong the remission time of the elderly patients with MG, can significantly improve the long-term efficiency of elderly women with MG.