Therapeutic trials in 200 patients with HTLV-I-associated myelopathy/tropical spastic paraparesis
Therapeutic trials in 200 patients with HTLV-I-associated myelopathy/tropical spastic paraparesis
复制标题
DOI：
10.3109/13550289609146899
复制
发表时间：
1996-10-01
影响因子：
3.2
通讯作者：
Osame, M
中科院分区：
文献类型：
--
作者：
Nakagawa, M;Nakahara, K;Osame, M
我们在此报告 1986 年至 1993 年间在我们科室进行的 200 名 HTLV-I 相关脊髓病 (HAM)/热带痉挛性截瘫 (TSP) 患者的治疗试验结果。通过口服泼尼松龙，69.5% (91/131) 的患者运动功能障碍等级改善了一级以上，仅服用盐酸乙哌立松，50% (3/6) 的患者运动功能障碍等级改善了 1 级以上。 血液净化（淋巴细胞去除和血浆去除）43.8%（7/16），鞘内注射氢化可的松40.0%（2/5），静脉注射大剂量甲泼尼龙30.0%（3/10），干扰素-α（肌肉注射和吸入）23.3%（10/43）， 硫唑嘌呤 22.2% (2/9)、高剂量维生素 C 20.0% (4/20)、红霉素 16.0% (4/25)、柳氮磺胺吡啶 12.5% (3/24)、咪唑立宾 11.8% (2/17)、7.1% (1/14)磷霉素，6.3% (1/16) 通过促甲状腺激素释放激素。除一名因巨细胞病毒感染而患有成人呼吸窘迫综合征的患者和一名患有药物性肝炎肝功能衰竭的患者外，没有发现这些疗法的严重副作用。 HAM/TSP 患者的治疗选择必须根据年龄、性别、疾病严重程度和并发症来考虑，以减少不良事件并提高生活质量。尽管结果是对 200 名 HAM/TSP 患者进行开放试验的不同治疗的概要，但我们认为这是针对 HAM/TSP 患者进行大规模治疗试验的第一份报告。本研究结果表明，免疫调节疗法对HAM/TSP具有一定的有益作用，并且这些药物的功能与该疾病的病理生理学相关。
We report here the results of therapeutic trials in 200 patients with HTLV-I-associated myelopathy (HAM)/tropical spastic paraparesis (TSP) conducted in our department between 1986 and 1993. Motor disability grades were improved by more than one grade in 69.5% (91/131) of patients by oral administration of prednisolone, 50% (3/6) by eperisone hydrochloride only, 43.8% (7/16) by blood purification (lymphocytapheresis and plasmapheresis), 40.0% (2/5) by intrathecal injection of hydrocortisone, 30.0% (3/10) by intravenous injection of high-dose methylprednisolone, 23.3% (10/43) by interferon-alpha (intramuscular injection and inhalation), 22.2% (2/9) by azathioprine, 20.0% (4/20) by high-dose vitamin C, 16.0% (4/25) by erythromycin, 12.5% (3/24) by salazosulfa-pyridine, 11.8% (2/17) by mizoribine, 7.1% (1/14) by fosfomycin, and 6.3% (1/16) by thyrotropin releasing hormone. No critical side effects of these therapies were seen with the exceptions of one patient with adult respiratory distress syndrome due to cytomegalovirus infection and one patient with drug-induced hepatitismepatic failure. Selection ofthese treatments for patients with HAM/TSP must be considered on the basis of age, sex, disease severity and complications to reduce adverse events and to improve quality of life. Although the results were a synopsis of different treatments given to 200 patients with HAM/TSP as an open trial, we consider this the first report of a large-scale therapeutic trial in patients with HAM/TSP. The results of this study indicate that immunomodulatory therapies have some beneficial effects in HAM/TSP, and the functions of these agents are related to the pathophysiology of this disease.