健脾益肾法联合西药治疗耐受糖皮质激素重症肌无力临床研究

Clinical Study of Strengthening Pi and Nourishing Shen Therapy Combined with Western Medicine on Patients with Glucocorticoid Resistant Myasthenia Gravis

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中文关键词: 重症肌无力糖皮质激素耐受健脾益肾

英文关键词:myasthenia gravis glucocorticoid resistance strengthening Pi and nourishing Shen

基金项目:广东省医学科研基金资助项目(No.A2006177);广东省自然科学基金资助项目(No.06300815)

作者	单位
刘小云	中山大学附属第一医院中医科
陈松林	中山大学附属第一医院神经科
张为西	中山大学附属第一医院神经科

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中文摘要:

目的探讨健脾益肾法治疗耐受糖皮质激素(glucocorticoids,GC)重症肌无力(myasthenia gra-vis,MG)的有效途径。方法将27例经胆碱酯酶抑制剂和GC系统治疗后症状复发,再次经GC治疗产生耐受性的MG患者,分为脾肾气阴两虚型(15例)和脾肾阳虚型(12例)两组。西药均用甲泼尼龙及溴吡斯的明;中药治疗脾肾气阴两虚型用补中益气丸及六味地黄丸,脾肾阳虚型用补中益气丸及滋肾育胎丸;溴吡斯的明、甲泼尼龙、中成药用量均随治疗时间的延长而递减。治疗根据用药情况依次分为症状治疗、恢复乙酰胆碱受体功能、调节免疫功能和强化个体机能4个阶段。所有病例在治疗各阶段前后复查肌力和整体状态。结果27例患者1年内完全缓解9例,药物缓解7例,显著改善5例,中度改善1例,不变3例,死亡2例。结论中西医结合治疗耐受糖皮质激素MG疗效确定,值得进一步探索。

英文摘要:

ObjectiveTo study the effect of strengthening Pi and nourishing Shen therapy(SPNST) in treating patients with glucocorticoid resistant myasthenia gravis(GR-MG).MethodsTwenty-seven patients with MG were enrolled,who were relapse cases after treated by cholinesterase inhibitor with systemic glucocorticoid treatment and showed resistance to glucocorticoid.All were treated by Western medicines,methylprednisolone(MP) and pyridostigmine bromide(PSB),together with Chinese medicine(CM) given according to their syndrome types,namely,for the 15 patients of Pi-Shen qi-yin deficiency type,Buzhong Yiqi Pill and Liuwei Dihuang Pill,and for the 12 patients of Pi-Shen yang-deficiency type,Buzhong Yiqi Pill and Zishen Yutai Pill.The dosages of medicines were reduced gradually in MP-PSB-CM order along with the progressing of the therapy in 4 stages(symptom curing,choline receptor restoration,immune regulation,and functional strengthening).Muscle strength and overall state of patients were re-examined before and after each of the 4 stages.ResultsAfter 1-year treatment,the therapeutic effect in 9 patients was judged as completely remitted;in 7 as remitted with continuous medication;in 5,1 and 3 as significantly improved,moderately improved and unchanged respectively,while 2 patients died.ConclusionIntegrative medicine shows definite effects in treating GR-MG,and it is worthy of further studying.

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