急性脊髓炎激素治疗的早期疗效分析
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摘要
目的
探讨大剂量甲强龙冲击疗法对急性脊髓炎早期恢复情况的影响。
方法
对中国医科大学附属第一医院1999年至2009年收治的76例急性脊髓炎的病例进行回顾性分析,包括临床表现、实验室检查、影像学检查结果以及对激素治疗的反应。按照类固醇激素治疗的不同方式,分甲基强的松龙组(甲强组)和氢化可的松组(氢考组),对两组的早期疗效进行比较。并对甲强组患者的性别、年龄、MRI脊髓受累情况、脑脊液中细胞数及蛋白含量与急性脊髓炎患者早期恢复情况的相关性进行分析。
结果
在急性脊髓炎恢复早期,甲强组患者神经功能缺损评分提高3.44±2.430分,氢考组提高2.04±1.717分,P=0.005；甲强组中,脑脊液中蛋白含量增高组神经功能缺损评分提高4.18±2.378分,正常组提高2.38±2.145分,P=0.020。
结论
大剂量甲强龙冲击疗法在治疗急性脊髓炎上优于小剂量氢化可的松疗法,尤其在脑脊液蛋白含量高于正常的患者中疗效更为显著。
The data of 76 patients were reviewed retrospectively form first affiliated hospital of china medical university between 1999 and 2009. To analyze the clinical situation, laboratory examination, imaging examination. To compare the different therapeutic efficacy between high does methylprednisolone group and ordinary hydrocortisone group. To compare the action of sex, age, MRI features, cells and protein content of cerebrospinal fluid for patients with high does methylprednisolone.
Results
The therapeutic effect was different between the methylprednisolone and the control group(P<0.05). In the high does methylprednisolone group, the therapeutic effect of the cerebrospinal fluid protein content higher group is much better than the normal group(P<0.05).
Conclusion
The therapeutic effect of high does methylprednisolone was significantly better than the ordinary hydrocortisone group. Especially for the cerebrospinal fluid protein content higher patients.
Key words
acute myelitis; steroids; cerebrospinal fluid protein content; therapeutic efficacy
探讨大剂量甲强龙冲击疗法对急性脊髓炎早期恢复情况的影响。
方法
对中国医科大学附属第一医院1999年至2009年收治的76例急性脊髓炎的病例进行回顾性分析,包括临床表现、实验室检查、影像学检查结果以及对激素治疗的反应。按照类固醇激素治疗的不同方式,分甲基强的松龙组(甲强组)和氢化可的松组(氢考组),对两组的早期疗效进行比较。并对甲强组患者的性别、年龄、MRI脊髓受累情况、脑脊液中细胞数及蛋白含量与急性脊髓炎患者早期恢复情况的相关性进行分析。
结果
在急性脊髓炎恢复早期,甲强组患者神经功能缺损评分提高3.44±2.430分,氢考组提高2.04±1.717分,P=0.005；甲强组中,脑脊液中蛋白含量增高组神经功能缺损评分提高4.18±2.378分,正常组提高2.38±2.145分,P=0.020。
结论
大剂量甲强龙冲击疗法在治疗急性脊髓炎上优于小剂量氢化可的松疗法,尤其在脑脊液蛋白含量高于正常的患者中疗效更为显著。
The data of 76 patients were reviewed retrospectively form first affiliated hospital of china medical university between 1999 and 2009. To analyze the clinical situation, laboratory examination, imaging examination. To compare the different therapeutic efficacy between high does methylprednisolone group and ordinary hydrocortisone group. To compare the action of sex, age, MRI features, cells and protein content of cerebrospinal fluid for patients with high does methylprednisolone.
Results
The therapeutic effect was different between the methylprednisolone and the control group(P<0.05). In the high does methylprednisolone group, the therapeutic effect of the cerebrospinal fluid protein content higher group is much better than the normal group(P<0.05).
Conclusion
The therapeutic effect of high does methylprednisolone was significantly better than the ordinary hydrocortisone group. Especially for the cerebrospinal fluid protein content higher patients.
Key words
acute myelitis; steroids; cerebrospinal fluid protein content; therapeutic efficacy
引文
1 Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis[J]. Neurology.2002; 59(4):499-505.
2 Berman M, Feldman S, Alter M, et al. Acute transverse myelitis:incidence and etiologic considerations[J]. Neurology.1981; 31 (8):966-971.
3 Al Deeb SM, Yaqub BA, Bruyn GW, et al. Acute transverse myelitis:A localized form of postinfectious encephalomyelitis[J]. Brain.1997; 120(7):1115-1122.
4 Oishi C, Sakuta M. Steroid therapy for multiple sclerosis[J]. Nippon Rinsho Kekkaku.2003; 61(8):1361-1366.
5 Van Koningsveld R, Van Doom PA. Steroids in the Guillain-Barre syndrome:is there a therapeutic window[J]. Neurologia.2005; 20(2):53-57.
6 Miyazawa R, Ikeuchi Y, Tomomasa T, et al. Determinants of prognosis of acute transverse myelitis in children[J]. Pediatrcs International.2003; 45(5):512-516.
7 Moser J, Liptai Z, Veres E, Rosdy B, et al. Acute transverse myelitis in childhood[J]. Ideggyogy Sz.2009,62(11-12):405-410
8 Defresne P, Meyer L, Tardieu M, et al. Efficacy of high dose steroid therapy in children with severe acute transverse myelitis[J]. Neurology Neurosurg Psychiatry.2001; 71(2):272-274.
9 郭沂涟,李义召,孙琳,等.甲基强的松龙冲击疗法治疗神经免疫性疾病的研究[J].临床神经病学杂志.2000,13(1)：55-56.
10吴江.神经病学[M].北京：人民卫生出版社.2005；138.
11 Murthy JM, Reddy JJ, Meena AK, et al. Acute transverse myelitis:MR characteristics[J]. Neurological society of India.1999; 47(4):290-293
12 Botelho RV, Daniel JW, Boulosa JL, et al. Effectiveness of methylprednisolone in the acute phase of spinal cord injuries:a systematic review of randomized controlled trials[J]. Rev Assoc Med Bras.2009; 55(6):729-737.
13 Arsura E, Brunner NG, Namba T, et al. High-dose intravenous methylprednisolone in myasthenia gravis[J]. Arch Neurol.1985; 42(12):1149-1153.
14 Thompson AJ, Kennard C, Swash M, et al. Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS[J]. Neurology.1989; 39(7):969-971.
15 Ellis MF. High-dose steroid therapy offers improvement in spinal cord injuries[J]. AACN Clin Issues Crit Care Nurs.1993; 4(3):566-572.
16 Nakashima S, Matsuyama Y, Yu Y, et al. Suppression of GDNF production by MPSS treatment following spinal cord injury in the rat[J]. Neuroreport.2004; 25(15):2337-2430.
17 Liu D, Li L, Augustus L. Prostaglandin release by spinal cord injury mediates production of hydroxyl radical, malondialdehyde and cell death:a site of the neuroprotective action of methylprednisolone[J]. J Neurochem.2001; 77(4):1036-1047.
18 Bernards CM, Akers T. Effect of postinjury intravenous or intrathecal methylprednisolone on spinal cord excitatory amino-acid release, nitric oxide generation, PGE2 synthesis, and myeloperoxidase content in a pig model of acute spinal cord injury[J]. Spinal Cord.2006; 44(10):594-604.
19 Braughler JM, Hall ED. Effects of multi-dose methylprednisolone sodium succinate administration on injured cat spinal cord neurofilament degradation and energy metabolism[J]. J N euro surgery.1984; 61(2):290-295.
20 Ray SK, Wilford GG, Matzelle DC, et al. Calpeptin and methylprednisolone inhibit apoptosis in rat spinal cord injury[J]. Ann NY Acad Sci.1999; 890:261-269.
1 Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis[J]. Neurology.2002; 59(4):499-505.
2 Jacob A, Weinshenker BG. An approach to the diagnosis of acute transverse myelitis[J]. Semin Neurol.2008; 28(1):105-120.
3 Kelley BJ, Erickson BJ, Weinshenker BG. Compressive myelopathy mimicking transverse myelitis[J]. Neurologist.2009; 16(2):120-122.
4 Hughes RAC. Acute necrotic myelopathy with pulmonary tuberculosis[J]. Brain.1977; 100(2): 223-238.
5 Pandit L. Transverse myelitis spectrum disorders[J]. Neurol India.2009; 57(2):126-133.
6 Harzheim M, Schlegel U, Urbach H, et al. Discriminatory features of acute transverse myelitis: a retrospective analysis of 45 patients[J]. J Neurol Sci.2004; 217(2):217-223.
7 Minami K, Tsuda Y, Maeda H, et al. Acute transverse myelitis caused by Coxsackie virus B5 infection[J]. J Paediatr Child Health.2004; 40(1-2):66-68.
8 李大年.现代神经内科学.山东科学技术出版社.2004;443.
9 Ohta M, Ohta K. Dction of myelin basic protein in cerebrospinal fluid[J]. Expert Rev Mol Diagn.2002; 2(6):627-633.
10 Agmon-Levin N, Kivity S, Szyper-Kravitz M, et al. Transverse myelitis and vaccines:a multi-analysis[J]. Lupus.2009; 18(13):1198-1204.
11 从美,王静艳,刘宁,等.水痘感染致脊髓损害1例并文献复习.中国实用内科杂志.2004；24(12)：767-768.
12 Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica:distinction from multiple sclerosis[J]. Lancet.2004; 364(9451):2106-2112.
13 Lennon VA, Kryzer TJ, Pittock SJ, et al. Ig G, marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel[J]. J Exp Med.2005; 202(4):473-477.
14 Wingerchuk DM, Lennon VA, Pittock SJ, et al. Revised diagnostic criteria for neuromyelitis optica[J]. Neurology.2006; 66(10):1485-1489.
15 Weinshenker BG, Wingerchuk DM, Vukusic S, et al. Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis[J]. Ann Neurol.2006; 59(3):566-569.
16 Hummers LK, Krishnan C, Casciola-Rosen L, et al. Recurrent transverse myelitis Associates with anti-Ro(SSA) autoantibodies. Neurology.2004; 62(1):147-149.
17 Icoz S, Tuzun E, Kurtuncu M, Durmu H, et al. Enhanced IL-6 production in aquaporin-4 antibody positive neuromyelitis optica patients[J]. Int J Neurosci.2009; 120(1):71-5.
18 Kaplin AL, Deshpande DM, Scott E, et al. IL-6 induces regionally selective spinal cord injury in patients with the neuroinflammatory disorder transverse myelitis. J Clin Invest.2005; 115(10):2731-2741.
19 Ravaglia S, Bastianello S, Franciotta D, et al. NMO-IgG-negative relapsing myelitis[J]. Spinal Cord.2009; 47(7):531-537.
20 Ray SK, Wilford GG, Matzelle DC, et al. Calpeptin and methylprednisolone inhibit apoptosis in rat spinal cord injury[J]. Ann N Y Acad Sci.1999; 890:261-269.
21 Thompson AJ, Kennard C, Swash M, et al. Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS[J]. Neurology.1989; 39(7):969-971
22耿同超,张忠华,王国相.静脉用免疫球蛋白在神经系统疾病中的应用[J].中华神经科杂志.2000；33(3)：158.
23 Llufuriu S, Castillo J, Blanco Y, et al. Plasma exchange for acute attacks of CNS demyelination:Predictors of improvement at 6 months[J]. Neurology.2009; 73(12):949-953.
24 Kim JK, Hong SH, Lee JK. High-level cervical spinal cord stimulation used to treat intractable pain arising from transverse myelitis caused by schistosomiasis[J]. J Korean Neurosurg Soc. 2009; 47(2):151-154.
25 Moser J, Liptai Z, Veres E, et al. Acute transverse myelitis in childhood[J]. Ideggyogy Sz.2009, 62(11-12):405-410.
26 Lee Jw, Park KS, Kim JH, et al. Diffusion tensor imaging in idiopathic acute transverse myelitis[J]. AJR Am J Roentgenol.2008; 191(2):W52-57.
27高平,秦绍森,时苗.影响急性脊髓炎患者预后的独立危险因素：神经功能缺损程度异常、MRI异常、体感诱发电位异常[J].中国临床康复.2004；8(34)：7652-7653.
2 Berman M, Feldman S, Alter M, et al. Acute transverse myelitis:incidence and etiologic considerations[J]. Neurology.1981; 31 (8):966-971.
3 Al Deeb SM, Yaqub BA, Bruyn GW, et al. Acute transverse myelitis:A localized form of postinfectious encephalomyelitis[J]. Brain.1997; 120(7):1115-1122.
4 Oishi C, Sakuta M. Steroid therapy for multiple sclerosis[J]. Nippon Rinsho Kekkaku.2003; 61(8):1361-1366.
5 Van Koningsveld R, Van Doom PA. Steroids in the Guillain-Barre syndrome:is there a therapeutic window[J]. Neurologia.2005; 20(2):53-57.
6 Miyazawa R, Ikeuchi Y, Tomomasa T, et al. Determinants of prognosis of acute transverse myelitis in children[J]. Pediatrcs International.2003; 45(5):512-516.
7 Moser J, Liptai Z, Veres E, Rosdy B, et al. Acute transverse myelitis in childhood[J]. Ideggyogy Sz.2009,62(11-12):405-410
8 Defresne P, Meyer L, Tardieu M, et al. Efficacy of high dose steroid therapy in children with severe acute transverse myelitis[J]. Neurology Neurosurg Psychiatry.2001; 71(2):272-274.
9 郭沂涟,李义召,孙琳,等.甲基强的松龙冲击疗法治疗神经免疫性疾病的研究[J].临床神经病学杂志.2000,13(1)：55-56.
10吴江.神经病学[M].北京：人民卫生出版社.2005；138.
11 Murthy JM, Reddy JJ, Meena AK, et al. Acute transverse myelitis:MR characteristics[J]. Neurological society of India.1999; 47(4):290-293
12 Botelho RV, Daniel JW, Boulosa JL, et al. Effectiveness of methylprednisolone in the acute phase of spinal cord injuries:a systematic review of randomized controlled trials[J]. Rev Assoc Med Bras.2009; 55(6):729-737.
13 Arsura E, Brunner NG, Namba T, et al. High-dose intravenous methylprednisolone in myasthenia gravis[J]. Arch Neurol.1985; 42(12):1149-1153.
14 Thompson AJ, Kennard C, Swash M, et al. Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS[J]. Neurology.1989; 39(7):969-971.
15 Ellis MF. High-dose steroid therapy offers improvement in spinal cord injuries[J]. AACN Clin Issues Crit Care Nurs.1993; 4(3):566-572.
16 Nakashima S, Matsuyama Y, Yu Y, et al. Suppression of GDNF production by MPSS treatment following spinal cord injury in the rat[J]. Neuroreport.2004; 25(15):2337-2430.
17 Liu D, Li L, Augustus L. Prostaglandin release by spinal cord injury mediates production of hydroxyl radical, malondialdehyde and cell death:a site of the neuroprotective action of methylprednisolone[J]. J Neurochem.2001; 77(4):1036-1047.
18 Bernards CM, Akers T. Effect of postinjury intravenous or intrathecal methylprednisolone on spinal cord excitatory amino-acid release, nitric oxide generation, PGE2 synthesis, and myeloperoxidase content in a pig model of acute spinal cord injury[J]. Spinal Cord.2006; 44(10):594-604.
19 Braughler JM, Hall ED. Effects of multi-dose methylprednisolone sodium succinate administration on injured cat spinal cord neurofilament degradation and energy metabolism[J]. J N euro surgery.1984; 61(2):290-295.
20 Ray SK, Wilford GG, Matzelle DC, et al. Calpeptin and methylprednisolone inhibit apoptosis in rat spinal cord injury[J]. Ann NY Acad Sci.1999; 890:261-269.
1 Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis[J]. Neurology.2002; 59(4):499-505.
2 Jacob A, Weinshenker BG. An approach to the diagnosis of acute transverse myelitis[J]. Semin Neurol.2008; 28(1):105-120.
3 Kelley BJ, Erickson BJ, Weinshenker BG. Compressive myelopathy mimicking transverse myelitis[J]. Neurologist.2009; 16(2):120-122.
4 Hughes RAC. Acute necrotic myelopathy with pulmonary tuberculosis[J]. Brain.1977; 100(2): 223-238.
5 Pandit L. Transverse myelitis spectrum disorders[J]. Neurol India.2009; 57(2):126-133.
6 Harzheim M, Schlegel U, Urbach H, et al. Discriminatory features of acute transverse myelitis: a retrospective analysis of 45 patients[J]. J Neurol Sci.2004; 217(2):217-223.
7 Minami K, Tsuda Y, Maeda H, et al. Acute transverse myelitis caused by Coxsackie virus B5 infection[J]. J Paediatr Child Health.2004; 40(1-2):66-68.
8 李大年.现代神经内科学.山东科学技术出版社.2004;443.
9 Ohta M, Ohta K. Dction of myelin basic protein in cerebrospinal fluid[J]. Expert Rev Mol Diagn.2002; 2(6):627-633.
10 Agmon-Levin N, Kivity S, Szyper-Kravitz M, et al. Transverse myelitis and vaccines:a multi-analysis[J]. Lupus.2009; 18(13):1198-1204.
11 从美,王静艳,刘宁,等.水痘感染致脊髓损害1例并文献复习.中国实用内科杂志.2004；24(12)：767-768.
12 Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica:distinction from multiple sclerosis[J]. Lancet.2004; 364(9451):2106-2112.
13 Lennon VA, Kryzer TJ, Pittock SJ, et al. Ig G, marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel[J]. J Exp Med.2005; 202(4):473-477.
14 Wingerchuk DM, Lennon VA, Pittock SJ, et al. Revised diagnostic criteria for neuromyelitis optica[J]. Neurology.2006; 66(10):1485-1489.
15 Weinshenker BG, Wingerchuk DM, Vukusic S, et al. Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis[J]. Ann Neurol.2006; 59(3):566-569.
16 Hummers LK, Krishnan C, Casciola-Rosen L, et al. Recurrent transverse myelitis Associates with anti-Ro(SSA) autoantibodies. Neurology.2004; 62(1):147-149.
17 Icoz S, Tuzun E, Kurtuncu M, Durmu H, et al. Enhanced IL-6 production in aquaporin-4 antibody positive neuromyelitis optica patients[J]. Int J Neurosci.2009; 120(1):71-5.
18 Kaplin AL, Deshpande DM, Scott E, et al. IL-6 induces regionally selective spinal cord injury in patients with the neuroinflammatory disorder transverse myelitis. J Clin Invest.2005; 115(10):2731-2741.
19 Ravaglia S, Bastianello S, Franciotta D, et al. NMO-IgG-negative relapsing myelitis[J]. Spinal Cord.2009; 47(7):531-537.
20 Ray SK, Wilford GG, Matzelle DC, et al. Calpeptin and methylprednisolone inhibit apoptosis in rat spinal cord injury[J]. Ann N Y Acad Sci.1999; 890:261-269.
21 Thompson AJ, Kennard C, Swash M, et al. Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS[J]. Neurology.1989; 39(7):969-971
22耿同超,张忠华,王国相.静脉用免疫球蛋白在神经系统疾病中的应用[J].中华神经科杂志.2000；33(3)：158.
23 Llufuriu S, Castillo J, Blanco Y, et al. Plasma exchange for acute attacks of CNS demyelination:Predictors of improvement at 6 months[J]. Neurology.2009; 73(12):949-953.
24 Kim JK, Hong SH, Lee JK. High-level cervical spinal cord stimulation used to treat intractable pain arising from transverse myelitis caused by schistosomiasis[J]. J Korean Neurosurg Soc. 2009; 47(2):151-154.
25 Moser J, Liptai Z, Veres E, et al. Acute transverse myelitis in childhood[J]. Ideggyogy Sz.2009, 62(11-12):405-410.
26 Lee Jw, Park KS, Kim JH, et al. Diffusion tensor imaging in idiopathic acute transverse myelitis[J]. AJR Am J Roentgenol.2008; 191(2):W52-57.
27高平,秦绍森,时苗.影响急性脊髓炎患者预后的独立危险因素：神经功能缺损程度异常、MRI异常、体感诱发电位异常[J].中国临床康复.2004；8(34)：7652-7653.