Immunosuppressive Treatments: Their Efficacy on Myasthenia Gravis Patients' Outcome and on the Natural Course of the Disease a
Immunosuppressive Treatments: Their Efficacy on Myasthenia Gravis Patients' Outcome and on the Natural Course of the Disease a
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免疫抑制治疗：对重症肌无力患者的预后和疾病自然病程的疗效
DOI：
10.1111/j.1749-6632.1993.tb22951.x
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发表时间：
1993
影响因子：
5.2
通讯作者：
F. Fiacchino
中科院分区：
文献类型：
--
作者：
F. Cornelio;C. Antozzi;R. Mantegazza;P. Confalonieri;E. Berta;D. Peluchetti;A. Sghirlanzoni;F. Fiacchino
重症肌无力(MG)的自然病程已被广泛研究，特别是1940-1960年和1960-1980年。前者在引入类固醇治疗和正压呼吸机之前。1940-1960年组与1960-1980年组MG的发病率和死亡率有显著差异。格罗布等人。他说：“这一改善主要归功于更好的呼吸护理，其次是皮质类固醇，这两种因素都提高了重症肌无力患者在病情最严重的早期的存活率，使患者能够进入随后几年的自发改善或稳定。”*然而，任何治疗方法的主要目标--稳定和完全缓解--仍远未实现，过去20年中报道的针对大量MG患者的不同流行病学研究的真实缓解率相似。‘-5由于明显的伦理原因，对MG患者所采取的治疗措施的疗效的评估通常依赖于回顾或非对照研究。临床结果的评估和“稳定缓解”的定义缺乏标准化，使得不同经验之间的比较特别困难。这种缺乏标准化可能解释了胸腺切除术和各种免疫抑制疗法的疗效相互矛盾的结果。然而，皮质类固醇、其他免疫抑制药物和血浆置换的增加似乎是导致患者获得药物缓解或临床显著改善的更高比例的原因。六八
The natural course of myasthenia gravis (MG) has been extensively investigated, with particular attention to the years 1940 to 1960 and 1960 to 1980.’The former period preceded the introduction of steroid treatment and positive pressure ventilation. Morbidity and mortality of MG were significantly different in the 1940-1960 group versus the 1960-1980 group. Grob et al. stated,“The improvement was attributed mainly to better respiratory care, and to a lesser extent to corticosteroid, both of which increased survival during the early period of maximal severity allowing patients to enter the subsequent years of spontaneous improvement or stability.”*The main goal of any therapeutic approach, however, a stable and complete remission, is still far from being achieved, as demonstrated by similar percentages of true remission in different epidemiological studies on large series of MG patients reported during the last two decades.’-5 The evaluation of the efficacy of therapeutic measures adopted in MG has often relied upon retrospective or uncontrolled studies, due to obvious ethical reasons. The lack of standardization in the assessment of the clinical outcome and in definition of what is meant by “stable remission” makes the comparison between different experiences particularly difficult. This lack of standardization might explain the conflicting results on the efficacy of thymectomy and of the various immunosuppressive therapies. The increased use of corticosteroids, other immunosuppressive drugs, and plasma exchange, however, seem to be responsible for higher percentages of patients achieving pharmacological remission or a significant clinical improvement. 6-8