摘要
目的观察低剂量利妥昔单抗治疗视神经脊髓炎谱系疾病(NMOSD)的长期疗效。方法回顾性收集2008年1月至2018年11月解放军总医院收治的NMOSD患者76例,其中男14例,女62例。根据治疗方案将患者分为利妥昔单抗(RTX)组(n=23)、硫唑嘌呤(AZA)组(n=32)及吗替麦考酚酯(MMF)组(n=21)。对患者进行长期随访,比较不同药物干预组患者间以及水通道蛋白4(AQP-4)抗体阳性与阴性患者间治疗前后扩展的残疾功能状态评分(EDSS)、年复发率(ARR)的差异,并记录各组患者不良反应情况。采用Kaplan-Meier生存分析比较不同药物组患者的复发情况。结果AQP4-Ab阳性或阴性患者3种药物治疗组间治疗前及治疗后EDSS评分和ARR比较均无统计学差异(均P>0.05)。与治疗前比较,AQP4-Ab阳性或阴性患者经不同药物治疗后其EDSS评分和ARR均下降(P<0.05,P<0.01)。RTX组、AZA组及MMF组患者治疗后其EDSS评分和ARR下降程度比较均无统计学差异(均P>0.05)。Kaplan-Meier生存分析结果显示RTX组患者累积无复发率较AZA组和MMF组高(P<0.05)。各组患者均未出现严重的不良反应。结论RTX、AZA及MMF均可有效降低AQP4-Ab阳性及阴性NMOSD患者的ARR和疾病残疾进展,低剂量RTX治疗NMOSD患者的累积复发率更低,但确切结论尚需进一步大样本研究。
Objective To observe the long-term effectiveness of low-dosage rituximab(RTX)treatment in patients with neuromyelitis optica spectrum disorders(NMOSD).Methods In this retrospective study,the effectiveness of immunosuppressive agents was investigated through long-term follow-up.To assess the long-term effectiveness and safety of rituximab(RTX,n=23),azathioprine(AZA,n=32)and mycophenolate mofetil(MMF,n=21)therapies,76 patients with NMOSD,including 14 male and 62 female were enrolled from January 2008 to November 2018 in General Hospital of Chinese PLA.The differences of pre-post expanded disability stale(EDSS)and pre-post annualized relapse rates(ARR)were compared between the three immunosuppressive agents groups and between the patients with seropositive and seronegative aquaporin-4 antibody(AQP4-Ab).Furthermore,the side effects were recorded.The recurrent frequencies were also compared between the three treatment groups according to the Kaplan-Meier survival analysis.Results There were no significant statistically differences in the changes of EDSS and ARR between three treatment groups in all AQP4-Ab seropositive(AQP4-Ab+)patients and seronegative(AQP4-Ab-)patients(P>0.05).The post-treatment ARR and EDSS scores were lower than that of the pre-treatment in AQP4-Ab+groups and AQP4-Ab-groups(P<0.05,P<0.01).There were no significant statistically differences between the post-treatment and pre-treatment changes of EDSS and ARR in RTX,AZA and MMF treatment groups(P>0.05).However,RTX-treated patients were more likely to be relapse-free after long-term follow-up than those who received AZA or MMF therapy according to Kaplan-Meier survival analysis.Moreover,there was no serious adverse events among these patients.Conclusions RTX,AZA and MMF therapies effectively lower the relapse frequency and reduced disability in patients with NMOSD(both seropositive and seronegative AQP4-Ab patients).The patients with low-dose RTX treatment has less recurrent frequency.However,the large sample investigations are needed.
作者
杨扬
陈利锋
武雷
姚甲瑞
王娜
苏小清
李冬梅
韩丽娜
吴卫平
黄德晖
蒋天裕
王振福
YANG Yang;CHEN Lifeng;WU Lei;YAO Jiarui;WANG Na;SU Xiaoqing;LI Dongmei;HAN Lina;WU Weiping;HUANG Dehui;JIANG Tianyu;WANG Zhenfu(Department of Neurology,The Second Medical Center&National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)
出处
《中国神经免疫学和神经病学杂志》
CAS
北大核心
2022年第5期356-361,共6页
Chinese Journal of Neuroimmunology and Neurology
