本文選題：多發(fā)性硬化 + 血漿置換��； 參考：《南昌大學》2017年碩士論文

【摘要】：目的:多發(fā)性硬化(multiple sclerosis,MS)是一種以中樞神經(jīng)系統(tǒng)(central nervous system,CNS)脫髓鞘病變?yōu)樘攸c的自身免疫性疾病,臨床特點主要體現(xiàn)為異常病變在空間上多發(fā)性以及病情進展上的時間多發(fā)性。截止目前尚未發(fā)現(xiàn)治愈MS的有效方法。采用的治療方案一般為激素沖擊治療、血漿置換或兩者聯(lián)合治療。已在國內(nèi)外相關領域得到認可的首選藥物治療為糖皮質激素沖擊治療。我們在實際工作中會發(fā)現(xiàn)有不少急性期MS患者,即使確診后立即給予糖皮質激素沖擊治療,但效果效果并不理想。接下來該如何選擇治療?我們設想,在治療早期聯(lián)合血漿置換治療是否能夠改善患者預后呢?本研究設計單獨應用糖皮質激素與血漿置換聯(lián)合糖皮質激素對MS患者治療效果的比較,以提供臨床治療的依據(jù)。方法:本研究入組了2012年9月至2016年1月入住我院神經(jīng)內(nèi)科的MS患者,并且均為在急性治療初期對糖皮質激素沖擊治療不敏感的患者。入組標準:依據(jù)2010年中國MS診斷和治療專家共識,納入符合相關診斷標準的復發(fā)緩解型患者。激素沖擊治療不敏感定義:甲強龍靜脈滴注1.0g×5d后立即給予EDSS評分,顯示EDSS評分改善0.5分即為效果較差患者。入組病例數(shù)共計28例,其中男8例,女20例;年齡16-66歲,平均41.50±12.72歲;平均病程1.3年;平均急性期發(fā)病時間4.8d。所有入組研究對象被分為觀察組與對照組各14例。其中,14例對照組的患者給予靜脈注甲潑尼松龍,逐漸減量至口服甲潑尼松龍片;14例觀察組的患者,給予甲潑尼松龍靜脈滴注后聯(lián)合血漿置換治療。治療后,將兩組的臨床效果(EDSS評分)進行對比。觀察指標有:(1)激素改為口服(大約17天)時神經(jīng)功能障礙量表(EDSS)評分的改善情況,同時以顯效、有效和遲效作為判斷臨床療效的標準之一,總有效率(%)=(顯效+有效)/總例數(shù)×100%;(2)對照兩組患者3月后神經(jīng)功能障礙量表(EDSS)評分改善情況及復發(fā)(出現(xiàn)新的臨床癥狀主述為標準);(3)對照兩組患者治療期間各種不良反應的發(fā)生率。全部數(shù)據(jù)分析利用統(tǒng)計軟件SPSS17.0進行處理,各組連續(xù)性變量數(shù)據(jù)以x±s形式呈現(xiàn),組間差異比較采用t檢驗,計數(shù)資料使用χ2檢驗,以P0.05代表差異具有統(tǒng)計學意義。結果:經(jīng)過治療后兩組病人比較,(1)有效率方面,觀察組的總有效率為92.9%,對照組的總有效率57.1%,觀察組的治愈率顯著高于對照組,差異具有統(tǒng)計學意義(P0.05);(2)觀察組治療后的EDSS評分下降和對照組相比,有顯著變化,有統(tǒng)計學意義(P0.05);(3)兩組患者3月后神經(jīng)功能障礙量表(EDSS)評分改善情況有統(tǒng)計學意義(P0.05)及但臨床復發(fā)次數(shù),無統(tǒng)計學意義(P0.05)(4)兩組患者的輕微不良反應比較,結果無統(tǒng)計學意義(P0.05)。結論:經(jīng)過本研究得出,急性期對糖皮質激素沖擊治療不敏感的MS患者聯(lián)合血漿置換治療是安全、有效的。
[Abstract]:Objective: multiple sclerosis (MS) is an autoimmune disease characterized by demyelinating lesions of central nervous system (CNS). Up to now, no effective method has been found to cure MS. Hormone shock therapy, plasma exchange or a combination of both are commonly used. Glucocorticoid shock therapy has been recognized as the preferred drug therapy in related fields at home and abroad. We find that there are many MS patients in acute stage, even if they are given glucocorticoid impulse therapy immediately after diagnosis, but the effect is not satisfactory. How do you choose treatment next? We imagine that the combination of plasma-exchange therapy at the early stage of treatment can improve the prognosis of patients. The purpose of this study was to compare the efficacy of glucocorticoid and plasma exchange combined with glucocorticoid in the treatment of MS patients. Methods: MS patients admitted to our hospital from September 2012 to January 2016 were all insensitive to glucocorticoid shock therapy at the early stage of acute treatment. Admission criteria: according to the consensus of Chinese MS diagnosis and treatment experts in 2010, to include relapsed remission patients in accordance with relevant diagnostic criteria. The definition of insensitivity to hormone shock therapy: the EDSS score was given immediately after intravenous drip of 1.0 g 脳 5 d, which showed that 0.5 score of EDSS score was poor. A total of 28 cases were included, including 8 males and 20 females, aged 16-66 years (mean 41.50 鹵12.72 years), mean course of disease 1.3 years, mean onset time of acute stage 4.8 days. All the subjects were divided into observation group (n = 14) and control group (n = 14). Among them, 14 patients in the control group were treated with prednisolone intravenously, and gradually reduced to 14 patients in the observation group who were given meprednisolone intravenously and treated with plasma exchange after intravenous drip of methylprednisolone. After treatment, the clinical effects of the two groups were compared with EDSS scores. The observation measures include: 1) the improvement of EDSS score when the hormone changed to oral (about 17 days), and one of the criteria for judging the clinical curative effect was obvious effect, effective effect and late effect. Total effective rate (effective / total number of cases 脳 100) the improvement and recurrence of EDSSs in the two groups after 3 months of treatment (the new clinical symptoms are mainly described as the standard) the two groups of patients in the control group during the treatment of a variety of not The incidence of good reactions. All data analysis was processed by SPSS 17.0. The data of continuous variables in each group were presented in the form of x 鹵s. T test was used to compare the difference among groups, 蠂 2 test was used to count the data, and P0.05 was used to represent the difference. Results: after treatment, the total effective rate was 92.9 in the observation group and 57.1 in the control group. The cure rate of the observation group was significantly higher than that of the control group. The difference was statistically significant (P 0.05) the EDSS scores in the observation group decreased significantly compared with those in the control group. The improvement of EDSS score in the two groups after 3 months was statistically significant (P0.05), but the number of clinical recurrence was not statistically significant (P0.05 / 4). The results showed that there was no significant difference between the two groups in the slight adverse reactions (P 0.05). Conclusion: it is safe and effective to combine plasma exchange therapy with glucocorticoid shock therapy in MS patients in acute phase.
【學位授予單位】：南昌大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R744.51

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本文編號：2022797