2021 年第 5 期 第 16 卷

健脾益肾举陷汤联合西药治疗重症肌无力临床研究

Clinical study on the treatment of myasthenia gravis with Jianpi Yishen Juxian decoction combined with western medicine

作者：魏东生罗利俊杨洁丁君

英文作者：Wei Dongsheng Luo Lijun Yang Jie Ding Jun

单位：武汉市第一医院武汉市中西医结合医院神经内科430022

英文单位：Department of Neurology Wuhan No.1 Hospital Wuhan Hospital of Traditional Chinese and Western Medicine Wuhan 430022 China

关键词：重症肌无力；健脾益肾举陷汤；西药

英文关键词：Myastheniagravis；JianpiYishenJuxiandecoction;Westernmedicine

• 摘要：

• 目的 探讨健脾益肾举陷汤联合西药治疗重症肌无力（MG）的临床效果。方法 选取武汉市中西医结合医院神经内科2017年3月至2019年6月收治的75例MG患者（全身型），按照随机数字表法分为对照组（35例）和观察组（40例）。对照组采用常规西药治疗，观察组采用健脾益肾举陷汤联合西药治疗。比较2组临床疗效，治疗前后免疫指标水平，徒手肌力评定（MMT）、日常生活活动能力量表（ADL）、美国 MG 基金会（MGFA）疾病严重程度评价量表评分，乙酰胆碱受体抗体（AchR-Ab）水平及不良反应发生率。结果 观察组总有效率明显高于对照组［95.0%（38/40）比80.0%（28/35）］（P＜0.05）。治疗后，2组免疫球蛋白（Ig）M、IgG水平均明显高于治疗前，且观察组均明显高于对照组［（1.43±0.43）g/L比（1.14±0.21）g/L、（12.3±1.3）g/L比（8.3±1.6）g/L］（均P＜0.05）。治疗后，2组MMT评分、ADL评分及MGFA疾病严重程度评价量表评分均明显低于治疗前，且观察组均明显低于对照组［（11±4）分比（21±4）分、（2.9±0.6）分比（5.5±0.9）分、（7.9±1.6）分比（11.1±2.3）分］（均P＜0.05）。治疗后，2组AchR-Ab水平均明显低于治疗前，且观察组明显低于对照组［（1.62±0.25）nmol/L比（2.02±0.31）nmol/L］（均P＜0.05）。2组不良反应发生率比较，差异无统计学意义（P＞0.05）。结论 健脾益肾举陷汤联合西药治疗MG可有效提高临床疗效，缓解肌无力等症状，降低AchR-Ab 水平，提高生活能力，调节免疫功能，且安全性较好。

• Objective To investigate the clinical effect of Jianpi Yishen Juxian decoction combined with western medicine on myasthenia gravis (MG). Methods From March 2017 to June 2019, 75 MG patients (systemic type) admitted to the Department of Neurology, Wuhan Hospital of Traditional Chinese and Western Medicine were selected. They were randomly divided into the control group (35 cases) and the observation group (40 cases). The control group was treated with conventional western medicine, and the observation group was treated with Jianpi Yishen Juxian decoction combined with western medicine. The clinical efficacy, immune indexes level, manual muscle test (MMT), activities of daily living scale (ADL), MG Foundation of America (MGFA) disease severity assessment scale scores, the level of acetylcholine receptor antibody (AchR-Ab) and the incidence of complications were compared between the two groups. Results The total effective rate of the observation group was significantly higher than that of the control group ［95.0%(38/40) vs 80.0%(28/35)］(P＜0.05). After treatment, immunoglobulin(Ig) M and IgG levels in the two groups were significantly higher than those before treatment, and those in the observation group were significantly higher than those in the control group［（1.43±0.43）g/L vs （1.14±0.21）g/L,（12.3±1.3）g/L vs （8.3±1.6）g/L］(all P＜0.05). After treatment, MMT score, ADL score and MGFA disease severity assessment scale score of the two groups were significantly lower than those before treatment, and those in the observation group were significantly lower than those in the control group［（11±4） vs （21±4）, （2.9±0.6） vs （5.5±0.9）, （7.9±1.6） vs （11.1±2.3）］(all P＜0.05). After treatment, the levels of AchR-Ab in both groups were significantly lower than that before treatment, and that in the observation group was significantly lower than that in the control group［（1.62±0.25）nmol/L vs （2.02±0.31）nmol/L］(all P＜0.05). There was no significant difference in the incidence of complications between the two groups (P＞0.05). Conclusion The treatment of MG with Jianpi Yishen Juxian decoction combined with western medicine can effectively improve the clinical efficacy, relieve myasthenia and other symptoms, reduce AchR-Ab level, improve living ability, and regulate immune function， with good safety.