Objective To investigate the clinical effect of different immunosuppressive treatment regimens in children with ocular myasthenia gravis (OMG). Methods A retrospective analysis was conducted on 130 children with OMG who were treated in the Department of Neurology, Jiangxi Children's Hospital, from February 2018 to February 2023. According to the treatment regimen, they were divided into four groups: glucocorticoid (GC) group (n=29), mycophenolate mofetil (MMF) group (GC+MMF; n=33), methotrexate (MTX) group (GC+MTX; n=30), and tacrolimus (FK506) group (GC+FK506; n=38). Treatment outcomes and adverse reactions were compared among the groups. Results After 3 months of treatment, the FK506 group had significantly lower scores of Myasthenia Gravis Quantitative Scale and Myasthenia Gravis-Specific Activities of Daily Living than the other three groups (P<0.05). After 3 months of treatment, the FK506 group had a significantly lower dose of prednisone than the GC group, and after 6 and 9 months of treatment, the MMF, MTX, and FK506 groups had a significantly lower dose of prednisone than the GC group (P<0.05). After 12 months of treatment, the MMF, MTX, and FK506 groups had a significantly lower incidence rate of GC-related adverse reactions than the GC group (P<0.05). Conclusions For children with OMG, the addition of various immunosuppressants can reduce the dosage of GC and adverse reactions. Among them, FK506 shows superior efficacy compared to other immunosuppressants in the early treatment of OMG.
Key words
Myasthenia gravis /
Ocular type /
Immunosuppressant /
Glucocorticoid /
Clinical effect /
Adverse reaction /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
1 晏显妮, 吴苑, 廖桂彬, 等. 儿童眼肌型重症肌无力转换为全身型相关因素研究[J]. 中国神经精神疾病杂志, 2021, 47(12): 705-709. DOI: 10.3969/j.issn.1002-0152.2021.12.001.
2 陈頔, 张华, 殷剑, 等. 重症肌无力患者他克莫司血药浓度监测与CYP3A5基因检测分析[J]. 中国神经免疫学和神经病学杂志, 2020, 27(3): 206-209. DOI: 10.3969/j.issn.1006-2963.2020.03.008.
3 宋群. 他克莫司联合甲泼尼龙治疗重症肌无力的效果观察[J]. 中国卫生标准管理, 2020, 11(18): 86-88. DOI: 10.3969/j.issn.1674-9316.2020.18.036.
4 李久伟, 方方, 任晓暾, 等. 他克莫司治疗儿童重症肌无力的疗效研究[J]. 中国当代儿科杂志, 2020, 22(9): 964-969. PMID: 32933627. PMCID: PMC7499454. DOI: 10.7499/j.issn.1008-8830.2004215.
5 Tannemaat MR, Verschuuren JJGM. Emerging therapies for autoimmune myasthenia gravis: towards treatment without corticosteroids[J]. Neuromuscul Disord, 2020, 30(2): 111-119. PMID: 32007304. DOI: 10.1016/j.nmd.2019.12.003.
6 中国免疫学会神经免疫分会. 中国重症肌无力诊断和治疗指南（2020版）[J]. 中国神经免疫学和神经病学杂志, 2021, 28(1): 1-12. DOI: 10.3969/j.issn.1006-2963.2021.01.001.
7 Lindberg C, Andersen O, Lefvert AK. Treatment of myasthenia gravis with methylprednisolone pulse: a double blind study[J]. Acta Neurol Scand, 1998, 97(6): 370-373. PMID: 9669469. DOI: 10.1111/j.1600-0404.1998.tb05968.x.
8 Sanders DB, Wolfe GI, Narayanaswami P, et al. Developing treatment guidelines for myasthenia gravis[J]. Ann N Y Acad Sci, 2018, 1412(1): 95-101. PMID: 29381223. DOI: 10.1111/nyas.13537.
9 王美萍, 张哲宇, 张圣, 等. 免疫抑制剂治疗重症肌无力伴胸腺异常患者的临床观察研究[J]. 中华全科医学, 2020, 18(12): 2002-2005. DOI: 10.16766/j.cnki.issn.1674-4152.001673.
10 李辉, 季成叶, 宗心南, 等. 中国0~18岁儿童、青少年身高、体重的标准化生长曲线[J]. 中华儿科杂志, 2009, 47(7): 487-492. PMID: 19951507. DOI: 10.3760/cma.j.issn.0578-1310.2009.07.003.
11 Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents[J]. Pediatrics, 2017, 140(3): e20171904. PMID: 28827377. DOI: 10.1542/peds.2017-1904.
12 中国高血压防治指南修订委员会, 高血压联盟（中国, 中华医学会心血管病学分会, 等. 中国高血压防治指南（2018年修订版）[J]. 中国心血管杂志, 2019, 24(1): 24-56. DOI: 10.3969/j.issn.1007-5410.2019.01.002.
13 中国医师协会儿科医师分会, 中国儿童体检专家共识小组, 《中国实用儿科杂志》编辑委员会. 中国儿童健康体检专家共识[J]. 中国实用儿科杂志, 2022, 37(8): 561-566. DOI: 10.19538/j.ek2022080601.
14 张燕楠, 符国展, 黄金菊. GCS冲击联合其他免疫抑制剂治疗重症肌无力的疗效评价[J]. 医学理论与实践, 2020, 33(17): 2831-2833. DOI: 10.19381/j.issn.1001-7585.2020.17.021.
15 赵思佳, 郭俊, 李柱一. 重症肌无力的治疗进展[J]. 中国临床医生杂志, 2021, 49(6): 649-652. DOI: 10.3969/j.issn.2095-8552.2021.06.006.
16 姚舒洋, 李小雪, 农靖颖, 等. 免疫检查点抑制剂相关性重症肌无力: 从诊断到治疗[J]. 中国肺癌杂志, 2020, 23(8): 685-688. PMID: 32752585. PMCID: PMC7467994. DOI: 10.3779/j.issn.1009-3419.2020.102.25.
17 王承亚. 免疫抑制剂治疗重症肌无力的Meta分析[D]. 天津: 天津医科大学, 2017.
18 沈洁, 臧海生, 徐蓓峥, 等. 重症肌无力的中西医治疗进展[J]. 现代中西医结合杂志, 2021, 30(36): 4089-4094. DOI: 10.3969/j.issn.1008-8849.2021.36.021.
19 Farmakidis C, Pasnoor M, Dimachkie MM, et al. Treatment of myasthenia gravis[J]. Neurol Clin, 2018, 36(2): 311-337. PMID: 29655452. PMCID: PMC6690491. DOI: 10.1016/j.ncl.2018.01.011.
20 Comacchio GM, Marulli G, Mammana M, et al. Surgical decision making: thymoma and myasthenia gravis[J]. Thorac Surg Clin, 2019, 29(2): 203-213. PMID: 30928002. DOI: 10.1016/j.thorsurg.2018.12.007.
21 王钟情, 张立波, 刘潺潺. 回顾性分析他克莫司在重症肌无力患者中的应用[J]. 神经损伤与功能重建, 2021, 16(2): 83-85. DOI: 10.16780/j.cnki.sjssgncj.20201038.
22 Cron MA, Maillard S, Villegas J, et al. Thymus involvement in early-onset myasthenia gravis[J]. Ann N Y Acad Sci, 2018, 1412(1): 137-145. PMID: 29125185. DOI: 10.1111/nyas.13519.
PDF(550 KB)
