儿童眼肌型重症肌无力不同免疫抑制剂治疗方案的回顾性分析

Clinical effect of different immunosuppressive treatment regimens in children with ocular myasthenia gravis: a retrospective analysis

摘要:

目的 探讨儿童眼肌型重症肌无力（ocular myasthenia gravis, OMG）不同免疫抑制剂治疗方案的效果。方法 回顾性选择2018年2月—2023年2月在江西省儿童医院神经内科治疗的OMG患儿130例为研究对象，按治疗方案分为4组：糖皮质激素（glucocorticoid, GC）29例（GC组），GC+吗替麦考酚酯（mycophenolate mofetil, MMF）33例（MMF组）、GC+氨甲蝶呤（methotrexate, MTX）30例（MTX组）、GC+他克莫司（tacrolimus, FK506）38例（FK506组），比较各组疗效及不良反应。结果 治疗3个月，FK506组重症肌无力定量评分量表、重症肌无力日常活动量表评分低于其他3组（P<0.05）。治疗3个月，FK506组泼尼松剂量低于GC组（P<0.05）；治疗6个月、9个月，MMF组、MTX组、FK506组泼尼松剂量均低于GC组（P<0.05）。治疗12个月，MMF组、MTX组、FK506组GC不良反应发生率均低于GC组（P<0.05）。结论 儿童OMG加用不同类型免疫抑制剂均可减少GC用量及不良反应，其中FK506在OMG治疗早期效果优于其他免疫抑制剂。

Abstract:

Objective To investigate the clinical effect of different immunosuppressive treatment regimens in children with ocular myasthenia gravis (OMG).Methods A retrospective analysis was conducted on 130 children with OMG who were treated in the Department of Neurology, Jiangxi Children's Hospital, from February 2018 to February 2023. According to the treatment regimen, they were divided into four groups: glucocorticoid (GC) group (n=29), mycophenolate mofetil (MMF) group (GC+MMF; n=33), methotrexate (MTX) group (GC+MTX; n=30), and tacrolimus (FK506) group (GC+FK506; n=38). Treatment outcomes and adverse reactions were compared among the groups.Results After 3 months of treatment, the FK506 group had significantly lower scores of Myasthenia Gravis Quantitative Scale and Myasthenia Gravis-Specific Activities of Daily Living than the other three groups (P<0.05). After 3 months of treatment, the FK506 group had a significantly lower dose of prednisone than the GC group, and after 6 and 9 months of treatment, the MMF, MTX, and FK506 groups had a significantly lower dose of prednisone than the GC group (P<0.05). After 12 months of treatment, the MMF, MTX, and FK506 groups had a significantly lower incidence rate of GC-related adverse reactions than the GC group (P<0.05).Conclusions For children with OMG, the addition of various immunosuppressants can reduce the dosage of GC and adverse reactions. Among them, FK506 shows superior efficacy compared to other immunosuppressants in the early treatment of OMG.