A型肉毒毒素重复治疗与首次治疗偏侧面肌痉挛的疗效比较
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摘要
目的:比较A型肉毒毒素重复治疗与首次治疗偏侧面肌痉挛的疗效。方法:选取2016—2018年邯郸市中心医院收治的偏侧面肌痉挛患者164例,根据A型肉毒毒素治疗的次数分组,其中76例首次接受A型肉毒毒素治疗的为首次治疗组,88例重复接受A型肉毒毒素治疗的为重复治疗组。观察两组患者的临床疗效、面神经电图、瞬目反射与不良反应发生情况。结果:重复治疗组患者的总有效率为100.00%(88/88),略高于首次治疗组的97.37%(74/76),但差异无统计学意义(P>0.05);重复治疗组患者的完全缓解率为70.45%(62/88),明显高于首次治疗组的60.53%(46/76),差异有统计学意义(P<0.05)。重复治疗组患者患侧运动神经传导复合肌肉动作电位(CMAP)振幅显著低于健侧,差异有统计学意义(P<0.05)。两组患者治疗前后CMAP差值(ΔCMAP),瞬目反射R1差值(ΔR1)、R2差值(ΔR2)和R3差值(ΔR3)的差异均无统计学意义(P>0.05)。重复治疗组患者的不良反应发生率为9.09%(8/88),明显低于首次治疗组的21.05%(16/76),差异有统计学意义(P<0.05)。结论:A型肉毒毒素重复治疗与首次治疗偏侧面肌痉挛的疗效相近,临床获益情况均较好,其中重复治疗方案的综合疗效更优。
OBJECTIVE: To compare the efficacy of repeated treatment and first treatment of botulinum toxin type A for hemifacial spasm. METHODS: Totally 164 patients with hemifacial spasm admitted into Handan Central Hospital from 2016 to 2018 were according to the number of treatment times for botulinum toxin type A, 76 patients who received botulinum toxin type A for the first time were set as the first treatment group, and 88 patients who received botulinum toxin type A repeatedly were set as the repeated treatment group. The clinical efficacy, facial nerve electrogram, blink reflex and adverse drug reactions of two groups were observed. RESULTS: The total effective rate was 100.00%(88/88) in the repeated treatment group, higher than 97.37%(74/76) in the first treatment group, yet the difference was not statistically significant(P>0.05). The complete response rate was 70.45%(62/88)in the repeated treatment group, significantly higher than that in the first treatment group 60.53%(46/76), and the difference was statistically significant(P<0.05). In the repeated treatment group, the amplitude of compound muscle action potential(CMAP) was significantly lower than that of the healthy side, and the difference was statistically significant(P<0.05). The differences in ΔCMAP, blink reflex ΔR1, ΔR2 and ΔR3 between two groups before and after treatment were not statistically significant(P>0.05). The incidence of adverse drug reactions in the repeated treatment group was 9.09%(8/88), significantly lower than that in the first treatment group [21.05%(16/76)], the difference was statistically significant(P<0.05). CONCLUSIONS: The repeated treatment of BTX-A for hemifacial spasm is similar to the first treatment, with better clinical benefits, among which the comprehensive efficacy evaluation of the repeated treatment scheme is better.
OBJECTIVE: To compare the efficacy of repeated treatment and first treatment of botulinum toxin type A for hemifacial spasm. METHODS: Totally 164 patients with hemifacial spasm admitted into Handan Central Hospital from 2016 to 2018 were according to the number of treatment times for botulinum toxin type A, 76 patients who received botulinum toxin type A for the first time were set as the first treatment group, and 88 patients who received botulinum toxin type A repeatedly were set as the repeated treatment group. The clinical efficacy, facial nerve electrogram, blink reflex and adverse drug reactions of two groups were observed. RESULTS: The total effective rate was 100.00%(88/88) in the repeated treatment group, higher than 97.37%(74/76) in the first treatment group, yet the difference was not statistically significant(P>0.05). The complete response rate was 70.45%(62/88)in the repeated treatment group, significantly higher than that in the first treatment group 60.53%(46/76), and the difference was statistically significant(P<0.05). In the repeated treatment group, the amplitude of compound muscle action potential(CMAP) was significantly lower than that of the healthy side, and the difference was statistically significant(P<0.05). The differences in ΔCMAP, blink reflex ΔR1, ΔR2 and ΔR3 between two groups before and after treatment were not statistically significant(P>0.05). The incidence of adverse drug reactions in the repeated treatment group was 9.09%(8/88), significantly lower than that in the first treatment group [21.05%(16/76)], the difference was statistically significant(P<0.05). CONCLUSIONS: The repeated treatment of BTX-A for hemifacial spasm is similar to the first treatment, with better clinical benefits, among which the comprehensive efficacy evaluation of the repeated treatment scheme is better.
引文
[1] 邹亚芬,贾晓燕,黄明,等.国产肉毒毒素治疗特发性偏侧面肌痉挛的长期疗效评价[J].神经损伤与功能重建,2017,12(5):450-452.
[2] 彭彬,申起,董红娟,等.A型肉毒毒素对偏侧面肌痉挛和良性特发性眼睑痉挛患者焦虑/抑郁状态的影响[J].中国神经精神疾病杂志,2017,43(10):603-607.
[3] Mauriello JA Jr.Blepharospasm,Meige syndrome,and hemifacial spasm:treatment with botulinum toxin[J].Neurology,1985,35(10):1499-1500.
[4] 吕传真,周良辅.实用神经病学[M].第4版.上海:上海科学技术出版社,2014:1-299.
[5] 滕海英,曹丽霞,王洋,等.A型肉毒素治疗面肌痉挛32例临床观察[J].中国病案,2016,17(12):94-96.
[6] Raghavendra Nayak,Anupkumar Chaudhuri,Aniruddha Chatto-padhyay,et al.Tentorial meningioma presenting as hemifacial spa-sm:An unusual clinical scenario[J].Asian J Neurosurg,2016,11(2):178-179.
[7] 刘睿,李钦涛,齐平建.A型肉毒毒素对比面神经显微血管减压术治疗面肌痉挛的疗效观察研究[J].重庆医学,2016,45(3):417-419.
[8] 向云,尉洋.不同浓度肉毒素注射治疗偏侧面肌痉挛的临床疗效及不良反应观察[J].中国临床医生杂志,2018,46(5):45-48.
[9] 邵银进,黄裕斌,吴桂华.外周神经电刺激引导下A型肉毒毒素注射治疗面肌痉挛57例观察[J].中国康复理论与实践,2016,22(3):323-325.
[10] 李归宿,刘秀峰,吴盛各,等.面神经传导检测对早期判断急性面神经炎神经损害程度及预后的分析[J].齐齐哈尔医学院学报,2013,34(16):2404-2405.
[11] 马英,胡细枚,袁裕钧,等.A型肉毒毒素治疗偏侧面肌痉挛临床分析[J].实用药物与临床,2016,19(5):584-587.
[12] Butera C,Guerriero R,Amadio S,et al.Functional end-plate recovery in long-term botulinum toxin therapy of hemifacial spasm:a nerve conduction study[J].Neurol Sci,2013,34(2):209-215.
[13] 张璇.A型肉毒毒素重复注射对偏侧面肌痉挛神经电生理影响的研究[D].大连:大连医科大学,2013:1-44.
[14] 谢春,高小平,梁辉,等.A型肉毒毒素治疗面肌痉挛方法改良疗效分析[J].医学与哲学,2017,38(12):61-62.
[2] 彭彬,申起,董红娟,等.A型肉毒毒素对偏侧面肌痉挛和良性特发性眼睑痉挛患者焦虑/抑郁状态的影响[J].中国神经精神疾病杂志,2017,43(10):603-607.
[3] Mauriello JA Jr.Blepharospasm,Meige syndrome,and hemifacial spasm:treatment with botulinum toxin[J].Neurology,1985,35(10):1499-1500.
[4] 吕传真,周良辅.实用神经病学[M].第4版.上海:上海科学技术出版社,2014:1-299.
[5] 滕海英,曹丽霞,王洋,等.A型肉毒素治疗面肌痉挛32例临床观察[J].中国病案,2016,17(12):94-96.
[6] Raghavendra Nayak,Anupkumar Chaudhuri,Aniruddha Chatto-padhyay,et al.Tentorial meningioma presenting as hemifacial spa-sm:An unusual clinical scenario[J].Asian J Neurosurg,2016,11(2):178-179.
[7] 刘睿,李钦涛,齐平建.A型肉毒毒素对比面神经显微血管减压术治疗面肌痉挛的疗效观察研究[J].重庆医学,2016,45(3):417-419.
[8] 向云,尉洋.不同浓度肉毒素注射治疗偏侧面肌痉挛的临床疗效及不良反应观察[J].中国临床医生杂志,2018,46(5):45-48.
[9] 邵银进,黄裕斌,吴桂华.外周神经电刺激引导下A型肉毒毒素注射治疗面肌痉挛57例观察[J].中国康复理论与实践,2016,22(3):323-325.
[10] 李归宿,刘秀峰,吴盛各,等.面神经传导检测对早期判断急性面神经炎神经损害程度及预后的分析[J].齐齐哈尔医学院学报,2013,34(16):2404-2405.
[11] 马英,胡细枚,袁裕钧,等.A型肉毒毒素治疗偏侧面肌痉挛临床分析[J].实用药物与临床,2016,19(5):584-587.
[12] Butera C,Guerriero R,Amadio S,et al.Functional end-plate recovery in long-term botulinum toxin therapy of hemifacial spasm:a nerve conduction study[J].Neurol Sci,2013,34(2):209-215.
[13] 张璇.A型肉毒毒素重复注射对偏侧面肌痉挛神经电生理影响的研究[D].大连:大连医科大学,2013:1-44.
[14] 谢春,高小平,梁辉,等.A型肉毒毒素治疗面肌痉挛方法改良疗效分析[J].医学与哲学,2017,38(12):61-62.