【摘要】：一．目的 慢性炎癥性脫髓鞘性多發(fā)性神經(jīng)根神經(jīng)�。╟hronic inflammatorydemyelinating polyradiculoneuropathy, CIDP）是一類由免疫介導的運動感覺周圍神經(jīng)病，其病程呈慢性進展或緩解復發(fā)，多伴有腦脊液蛋白-細胞分離，電生理表現(xiàn)為周圍神經(jīng)傳導速度減慢、傳導阻滯及異常波形離散；病理顯示有髓纖維多灶性脫髓鞘、神經(jīng)內(nèi)膜水腫、炎細胞浸潤等特點。目前對CIDP有效的治療方法包括激素、血漿置換(PE)、大劑量靜脈用人血免疫球蛋白(IVIg)及免疫抑制劑(IS)等，其中激素是目前治療的首選藥物，但在CIDP的治療效果、神經(jīng)功能恢復及復發(fā)率等方面還是有許多問題亟待解決，同時長期使用激素所產(chǎn)生的副作用逐漸引起了學者的重視。本研究擬對: IVIg聯(lián)合糖皮質(zhì)激素與單獨應用糖皮質(zhì)激素對CIDP的治療效果對比，以供臨床參考。 二．方法 以2008年2月-2013年2月我院收治的CIDP患者68例為研究對象，將該組研究對象隨機分為對照組與觀察組各34例，對照組的34例患者進行靜脈注射注射用甲潑尼松龍，口服潑尼松，觀察組的34例患者在對照組治療基礎上，還靜脈注射免疫球蛋白。治療后，比較兩組的臨床療效。觀察指標有：①比較兩組四肢肌力指標：判斷肢體運動功能采用上下肢運動肌力評分Lovett6級分級法來進行評價；②比較生活能力指標：生活能力采用改良Barthel指數(shù)評價；③神經(jīng)功能指標：神經(jīng)功能采用ASIA神經(jīng)功能評分表來評價；④比較兩組臨床癥狀的恢復時間：包括四肢疼痛、感覺障礙消失的時間，腱反射、四肢肌力和肌張力恢復的時間；⑤比較兩組治療期間發(fā)生的不良反應：評價標準為兩組患者治療期間均進行血常規(guī)、肝腎功能、心電圖等檢查，同時記錄治療期間發(fā)生不良反應的例數(shù)、種類和程度。其中判斷臨床療效以顯效、有效和遲效為標準，總有效率（%）=（顯效+有效）/總例數(shù)×100%。統(tǒng)計學處理所有數(shù)據(jù)采用SPSS16.0統(tǒng)計軟件進行分析，各組數(shù)據(jù)以（x±s））表示，統(tǒng)計分析組間差異用t檢驗，技術資料的檢驗使用χ2檢驗，以P 0.05代表具有統(tǒng)計學意義。 三．結果 兩組治療后，①觀察組的治療總有效率為97.1%，對照組的治療總有效率為82.4%。兩組的數(shù)據(jù)差異具有統(tǒng)計學的意義，觀察組治愈有效率明顯高于對照組，有統(tǒng)計學意義（P 0.05）。②兩組治療前后的四肢肌力、生活能力以及神經(jīng)功能比較，治療前均無統(tǒng)計學意義（P0.05），治療后觀察組和對照組與治療前相比，，都有顯著變化，有統(tǒng)計學意義（P 0.05），且觀察組的四肢肌力評分、生活能力評分均顯著高于對照組，神經(jīng)功能評分顯著低于對照組，有統(tǒng)計學意義（P0.05）。③觀察組的四肢肌力、感覺障礙、腱反射等臨床癥狀指標恢復的時間顯著短于對照組，有統(tǒng)計學意義（P0.05）。④兩組患者均無嚴重不良反應出現(xiàn)，比較無統(tǒng)計學意義（P0.05）。 四．結論 相比單用糖皮質(zhì)激素治療CIDP，糖皮質(zhì)激素聯(lián)合免疫球蛋白應用能增強治療效果，迅速改善患者的癥狀，幫助患者恢復肌力、生活能力和神經(jīng)功能，在臨床值得應用。
[Abstract]:I. purpose
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a kind of immune-mediated motor-sensory peripheral neuropathy with a course of chronic progression or remission of recurrence, accompanied by protein-cell separation in cerebrospinal fluid (CSF), and electrophysiological manifestations of peripheral nerve conduction velocity slowing down. Currently, the effective treatments for CIDP include hormones, plasma exchange (PE), high dose intravenous human immunoglobulin (IVIg) and immunosuppressive agents (IS), among which hormones are the first choice. However, there are still many problems to be solved in the treatment of CIDP, the recovery of nerve function and the recurrence rate. At the same time, the side effects of long-term use of hormones have gradually attracted the attention of scholars.
Two. Method
Sixty-eight patients with CIDP admitted to our hospital from February 2008 to February 2013 were randomly divided into the control group and the observation group. 34 patients in the control group were given methylprednisolone for intravenous injection and oral prednisone. 34 patients in the observation group were given immunoglobulin intravenously on the basis of the treatment of the control group. After treatment, the clinical effects of the two groups were compared. The following indexes were observed: (1) Comparing the limb muscle strength indexes of the two groups: judging the limb motor function by Lovett 6 grading method; Comparing the living ability indexes: the living ability was evaluated by modified Barthel index; and (3) Neurological function indexes: Neurological function index; The recovery time of clinical symptoms of the two groups were compared, including limb pain, the time of disappearance of sensory disturbance, tendon reflex, limb muscle strength and muscle tension recovery time; _Comparing the adverse reactions occurred during the treatment of the two groups: evaluation criteria were blood routine, liver during treatment in both groups. Kidney function, electrocardiogram, etc. were examined, and the number, type and degree of adverse reactions were recorded. The clinical efficacy was judged by the criteria of marked, effective and delayed effect. The total effective rate (%)= (marked + effective) / the total number of cases (%) was 100%. All data were analyzed by SPSS16.0 statistical software, and the data of each group were expressed by (+) s). Statistical analysis of the differences between groups using t test, the test of technical data using_2 test, P 0.05 on behalf of statistical significance.
Three. Results
After treatment, the total effective rate was 97.1% in the observation group and 82.4% in the control group. The difference between the two groups was statistically significant. The cure effective rate of the observation group was significantly higher than that of the control group, with statistical significance (P 0.05). The muscle strength, life ability and nerve function of the extremities before and after treatment were compared between the two groups. There was no statistical significance (P 0.05). After treatment, the observation group and the control group had significant changes compared with before treatment, with statistical significance (P 0.05), and the observation group limb muscle strength score, ability to live score were significantly higher than the control group, nerve function score was significantly lower than the control group, with statistical significance (P 0.05). 3 The observation group limb muscle strength, feeling. The recovery time of clinical symptoms such as sensory disturbance and tendon reflex was significantly shorter than that of the control group (P 0.05). There was no significant difference between the two groups (P 0.05).
Four. Conclusion
Compared with glucocorticoid alone in the treatment of CIDP, glucocorticoid combined with immunoglobulin can enhance the therapeutic effect, rapidly improve the symptoms of patients, help patients to restore muscle strength, viability and nerve function, which is worthy of clinical application.
【學位授予單位】：南華大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R745.4

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