CAJ | 학술논문

目的：对于糖皮质激素冲击治疗效果欠佳的多发性硬化急性期患者，选择血浆置换治疗的有效性及安全性。方法回顾性收集了2010年1月至2012年1月入住江西省人民医院神经内科的多发性硬化急性期对糖皮质激素治疗效果欠佳的患者。入组标准采用2010年中国多发性硬化诊断和治疗专家共识（中华神经科杂志，2011；43（7）516-521）。均为对糖皮质激素冲击治疗治疗（静脉注射甲强龙1g×5d）效果不明显者（治疗后EDSS评分改善<0.5分），共计13例，其中男3例，女10例；年龄23-66岁，平均（40.08±4.09）岁；平均病程1.3年；平均急性期发病时间4.8d。所有13例患者均采用血浆置换治疗。治疗前后，均采用1983年Kurtzke JF的神经功能障碍量表（EDSS）的评分标准进行评分；比较血浆置换治疗后EDSS评分的改变。结果血浆置换开始前EDSS平均6.0分（2.5-8.5），血浆置换后6名(46.2%)患者EDSS改变<2分。5名患者(38.5%) EDSS改变为（2-4分）。2名患者(15.4%)的EDSS改善>4分。在所有接受血浆置换的病例中，治疗前的EDSS评分(6.154±0.61)，治疗后EDSS评分(3.846±0.65)(P=0.0167)。两组疗效比较：患者3次血浆置换治疗后的EDSS评分明显优于治疗前的EDSS评分（P<0.05），差异有统计学意义。结果显示所有13名患者在接受血浆置换后EDSS评分明显下降。平均EDSS评分下降2分。结论本研究进一步显示对于糖皮质激素治疗效果不明显的患者选择血浆置换治疗是有效安全的。
목적：대우당피질격소충격치료효과흠가적다발성경화급성기환자，선택혈장치환치료적유효성급안전성。방법회고성수집료2010년1월지2012년1월입주강서성인민의원신경내과적다발성경화급성기대당피질격소치료효과흠가적환자。입조표준채용2010년중국다발성경화진단화치료전가공식（중화신경과잡지，2011；43（7）516-521）。균위대당피질격소충격치료치료（정맥주사갑강룡1g×5d）효과불명현자（치료후EDSS평분개선<0.5분），공계13례，기중남3례，녀10례；년령23-66세，평균（40.08±4.09）세；평균병정1.3년；평균급성기발병시간4.8d。소유13례환자균채용혈장치환치료。치료전후，균채용1983년Kurtzke JF적신경공능장애량표（EDSS）적평분표준진행평분；비교혈장치환치료후EDSS평분적개변。결과혈장치환개시전EDSS평균6.0분（2.5-8.5），혈장치환후6명(46.2%)환자EDSS개변<2분。5명환자(38.5%) EDSS개변위（2-4분）。2명환자(15.4%)적EDSS개선>4분。재소유접수혈장치환적병례중，치료전적EDSS평분(6.154±0.61)，치료후EDSS평분(3.846±0.65)(P=0.0167)。량조료효비교：환자3차혈장치환치료후적EDSS평분명현우우치료전적EDSS평분（P<0.05），차이유통계학의의。결과현시소유13명환자재접수혈장치환후EDSS평분명현하강。평균EDSS평분하강2분。결론본연구진일보현시대우당피질격소치료효과불명현적환자선택혈장치환치료시유효안전적。
Objective Plasma exchange (PE) is applied to treat severe acute episodes of multiple sclerosis (MS) unresponsive to corticosteroids. Methods We retrospectively reviewed the medical records of 13 patients unresponsive to corticosteroids consec-utively treated by PE between January 2010 and January 2012. The EDSS scores after PE were measured to analyze the primary outcome. Results 10 patients (76.9%) were women,and the median age was 38 years (range 23-66 years). All patients had multi-ple sclerosis. At PE onset,the median EDSS score was 6.0(range 2.5-8.5). Six patients (46.2%) improved EDSS score<2. Five pa-tients (38.5%) improved EDSS score (2-4). Two patients (15.4%) improved EDSS score (>4). Among the all cases treated with PE, the EDSS scores after treatment (3.846+ 0.65) were statistically significantly decreased ,as comparred with the scores before treat-ment(6.154+0.61). (*P<0.05)EDSS score was significantly decreased in all 13 patients after PE treatment. The average EDSS score was decreased in 2 points. Conclusion This study further supports the efficacy of plasma exchange in the treatment of steroid un-responsive severe acute episodes of MS.