本文選題：視神經(jīng)脊髓炎 + 利妥昔單抗�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景:視神經(jīng)脊髓炎(neuromyelitis optica,NMO)是免疫介導(dǎo)的視神經(jīng)和脊髓同時(shí)或相繼受累的急性或亞急性原發(fā)性中樞神經(jīng)系統(tǒng)炎性脫髓鞘疾病[1],早在1870年英國醫(yī)生Sir Tomas Allbutt就注意到視力喪失可與脊髓疾病合并發(fā)生,當(dāng)時(shí)發(fā)現(xiàn)在5例急性脊髓炎的病員中,1例有眼部癥狀。1894年Devic和他的學(xué)生Gault復(fù)習(xí)了既往文獻(xiàn)報(bào)道中的16例病例和他們收治的2例雙眼失明患者,在其前后數(shù)日或數(shù)周伴發(fā)橫貫性或上升性脊髓炎,后被稱為Devic病。視神經(jīng)脊髓炎在非白種人如日本、中國等亞洲人群多見[2],在白種人如歐美等西方國家人群中少見。視神經(jīng)脊髓炎的癥狀較多發(fā)性硬化嚴(yán)重,復(fù)發(fā)率高于多發(fā)性硬化,且復(fù)發(fā)型患者預(yù)后較差,5年內(nèi)約半數(shù)患者出現(xiàn)單眼視力嚴(yán)重下降甚至失明,70%發(fā)生嚴(yán)重癱瘓,加重家庭和社會(huì)負(fù)擔(dān)。因此尋找有效的治療藥物改善癥狀,并減少復(fù)發(fā),具有重大現(xiàn)實(shí)意義。近年來國內(nèi)外相關(guān)研究表明,利妥昔單抗(RTX)治療NMO能有效改善癥狀、減少復(fù)發(fā)、延緩殘疾的進(jìn)展。目的:探討利妥昔單抗對(duì)視神經(jīng)脊髓炎患者的治療效果,并分析其安全性。方法:視神經(jīng)脊髓炎患者共62例,隨機(jī)分成兩組,研究組23例、對(duì)照組39例,所有入選者均簽署知情同意書。對(duì)照組給予激素沖擊治療,緩解期給予環(huán)磷酰胺靜脈滴注;研究組在急性期激素沖擊治療的基礎(chǔ)上,緩解期給予利妥昔單抗治療。2組患者分別在治療前及治療9周后進(jìn)行EDSS部分子項(xiàng)目評(píng)分包括錐體系功能、大腦功能、腦干功能、視覺或視神經(jīng)功能、感覺功能、膀胱直腸功能;并進(jìn)行中國視力表檢查、日常生活活動(dòng)能力評(píng)定。并觀察利妥昔單抗治療后的不良反應(yīng)。在治療后隨訪患者2年,了解有無復(fù)發(fā)。結(jié)果:治療9周后,研究組的視力、日常生活活動(dòng)能力明顯提高,優(yōu)于對(duì)照組(P0.05)。研究組EDSS部分子項(xiàng)目評(píng)分變化優(yōu)于對(duì)照組,功能恢復(fù)明顯優(yōu)于對(duì)照組(P0.05)。研究組用藥后未出現(xiàn)嚴(yán)重不良反應(yīng),首次用藥時(shí)有輕度不良反應(yīng),在后三次用藥時(shí)不良反應(yīng)未再出現(xiàn)。隨訪2年后發(fā)現(xiàn),研究組復(fù)發(fā)率明顯低于對(duì)照組。結(jié)論:利妥昔單抗聯(lián)合激素沖擊治療視神經(jīng)脊髓炎效果顯著,明顯改善患者視力及神經(jīng)功能,降低致殘率,提高日常生活能力。治療過程安全有效。同時(shí)能顯著降低復(fù)發(fā)率。
[Abstract]:Background: neuromyelitis (NMOO) is an acute or subacute primary central nervous system inflammatory demyelinating disease involving the optic nerve and spinal cord simultaneously or sequentially [1]. As early as 1870, Sir Tomas Allbutt, a British doctor, noticed the vision. Loss of strength can be associated with spinal cord disease, One of the five patients with acute myelitis was found to have ocular symptoms. In 1894, Devic and his student Gault reviewed 16 previously reported cases and 2 binocular blindness patients they treated. Transversal or ascending myelitis occurs days or weeks before and after it is called Devic's disease. Optic neuromyelitis is more common in non-white people such as Japan and China than in white people such as Europe and America. The symptom of optic neuromyelitis was more serious than that of multiple sclerosis, the recurrence rate was higher than that of multiple sclerosis, and the prognosis of recurrent patients was poor. Increase the burden on families and society. Therefore, it is of great practical significance to find effective drugs to improve symptoms and reduce recurrence. Recent studies at home and abroad have shown that Rituximab can effectively improve symptoms, reduce recurrence and delay the progress of disability in the treatment of NMO. Objective: to evaluate the efficacy and safety of rituximab in the treatment of optic neuromyelitis. Methods: a total of 62 patients with optic neuromyelitis were randomly divided into two groups: study group (n = 23) and control group (n = 39). The control group was treated with hormone shock and cyclophosphamide was given intravenously in the remission period; the study group was treated with hormone shock therapy in the acute phase. The patients in group 2 were given Rituximab in the remission period before and 9 weeks after treatment. The scores of EDSS subitems included pyramidal function, brain function, brainstem function, visual or optic nerve function, sensory function, bladder and rectum function. And the Chinese visual acuity chart examination, daily life activity ability evaluation. The adverse effects of rituximab were observed. The patients were followed up for 2 years to see if there was recurrence. Results: after 9 weeks of treatment, the visual acuity and activity of daily living in the study group were significantly improved, which was better than that in the control group (P 0.05). The scores of EDSS subitems in the study group were better than those in the control group, and the functional recovery was significantly better than that in the control group (P 0.05). In the study group, there were no serious adverse reactions, mild adverse reactions at the first time, and no adverse reactions at the last three times. After 2 years follow-up, the recurrence rate in the study group was significantly lower than that in the control group. Conclusion: Rituximab combined with hormone shock therapy is effective in the treatment of optic neuromyelitis, which can obviously improve the visual acuity and nerve function, reduce the rate of disability and improve the ability of daily living. The treatment process is safe and effective. At the same time, the recurrence rate was significantly reduced.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R744.52

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