常规静脉给药联合鞘内药物注射治疗急性期视神经脊髓炎谱系疾病的临床疗效研究

doi:10.12114/j.issn.1007-9572.2019.00.816

摘要/Abstract

摘要： 背景　视神经脊髓炎谱系疾病（NMOSD）是一种对视神经、脊髓及大脑均具侵袭性的脱髓鞘疾病，虽然NMOSD已从多发性硬化症（MS）中独立出来，但二者在发病机制、基因易感以及治疗策略等方面存在差异的同时亦有重叠或相似的部分，近年来，鞘内药物注射治疗MS取得了良好的效果，但该方法对于NMOSD的治疗效果尚未明朗，临床有必要对此进一步明确。目的　观察常规静脉给药联合鞘内药物注射治疗急性期NMOSD的疗效。方法　选取2014年1月—2016年6月在新乡市中心医院神经内科住院确诊的急性期NMOSD患者104例，按随机数字表法将患者分为观察组72例和对照组32例，观察组根据干预方法分为观察亚组1（n=37）、观察亚组2（n=35）。患者均采用1~2种静脉药物行静脉注射常规治疗，观察亚组1在以上常规静脉给药基础上给予地塞米松（5.0 mg•次-1•d-1）与甲氨蝶呤（2.5 mg•次-1•d-1）联合行鞘内药物注射治疗；观察亚组2在常规静脉给药基础上选择地塞米松（5.0 mg•次-1•d-1）或甲氨蝶呤（2.5 mg•次-1•d-1）行鞘内药物注射治疗。治疗时间均在4周以上，出院后均随访24个月。统计患者的性别、年龄、入/出院神经功能缺损〔扩展的功能障碍状况量表（EDSS）及其部分子项目〕情况及差值、入/出院日常生活能力〔日常生活能力量表（ADL）〕水平及差值、观察亚组1和观察亚组2的鞘内药物注射次数。结果　观察组出院EDSS评分低于对照组，入/出院EDSS评分差值大于对照组（P<0.05）。观察亚组1入/出院EDSS评分差值大于观察亚组2（P<0.05）；观察亚组1出院EDSS评分低于观察亚组2（P<0.05）。随访13~18、19~24个月观察组复发率低于对照组（P<0.05）。结论　与单纯静脉给药的治疗方式比较，联合鞘内药物注射治疗急性期NMOSD在改善患者运动功能、降低残疾程度及远期复发率方面具有明显优势，地塞米松与甲氨蝶呤的联合鞘内药物注射较两种药物之一的单药鞘内药物注射效果更佳。

关键词: 视神经脊髓炎；注射, 脊髓；治疗结果；地塞米松；甲氨蝶呤

Abstract: Background　Neuromyelitis optica spectrum disorder（NMOSD） is a demyelinating disease invading the optic nerve，spinal cord and brain.Although NMOSD has been isolated from multiple sclerosis（MS），there are differences as well as overlapping or similarities in pathogenic mechanism，gene susceptibility and treatment strategies of the two.In recent years，intrathecal drug therapy has achieved good results in the treatment of MS，but its therapeutic effect on NMOSD is not clear.It is necessary to further clarify this.Objective　To observe the efficacy of conventional intravenous combined intrathecal drug therapy in the treatment of acute NMOSD.Methods　A total of 104 inpatients with acute NMOSD from Department of Neurology，Xinxiang Central Hospital were enrolled from January 2014 to June 2016，and were randomized into the control group（n=32） and observation group（n=72）.The observation group was further stratified into observation subgroup 1（n=37） and observation subgroup 2（n=35） by intervention method.All of the participants received conventional intravenous therapy with one or two drugs，observation subgroup 1 and subgroup 2 additionally received conventional intravenous with dexamethasone（5.0 mg once every day） and methotrexate（2.5 mg once every day），dexamethasone（5.0 mg once every day） or methotrexate（2.5 mg once every day），respectively.All of them were given a post-discharge follow-up of 24 months after being treated for at least 4 weeks.Sex，age，neurological impairment status on admission and at discharge〔assessed by the Expanded Disability Status Scale（EDSS） and some of its subscales〕，independent living skills on admission and at discharge 〔assessed by the Activities of Daily Living（ADL） Scale〕 of all participants，and number of intrathecal injections of those in the observation group were collected.Results　Compared with the control group，the observation group showed a lower mean EDSS score at discharge，and a lower difference value between mean EDSS scores on admission and at discharge（P<0.01）.The observation subgroup 1 demonstrated a greater difference value between mean EDSS scores on admission and at discharge（P<0.05），and a lower mean EDSS score at discharge compared with observation subgroup 2（P<0.05）.The recurrence rate of the observation group was lower than that of the control group during 13-18,19-24 months after discharge（P<0.05）.Conclusion　Compared with intravenous drug therapy alone，intravenous and intrathecal drug therapies have more obvious advantages in improving motor function recovery，reducing disability level and long-term recurrence rate.In particular，intrathecal injection of dexamethasone or methotrexate is inferior to the combination use of these two.

Key words: Neuromyelitis optica；Injections, spinal；Treatment outcome；Dexamethasone；Methotrexate

乔燕燕,刘斌,路燕. 常规静脉给药联合鞘内药物注射治疗急性期视神经脊髓炎谱系疾病的临床疗效研究[J]. 中国全科医学, 2020, 23(12): 1513-1516. DOI: 10.12114/j.issn.1007-9572.2019.00.816.
QIAO Yanyan,LIU Bin,LU Yan. Clinical Efficacy of Conventional Intravenous and Intrathecal Drug Therapies in Acute Neuromyelitis Optica Spectrum Disorders　[J]. Chinese General Practice, 2020, 23(12): 1513-1516. DOI: 10.12114/j.issn.1007-9572.2019.00.816.

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