摘要
目的 探讨他克莫司治疗老年眼肌型重症肌无力的临床疗效。方法 回顾性分析2020年1月至2023年6月首都医科大学附属北京同仁医院神经内科诊治的老年眼肌型重症肌无力患者资料,根据药物治疗情况分为糖皮质激素组和他克莫司组,比较两组患者的临床缓解和药物相关不良反应发生情况;同时分析他克莫司组CYP3A5基因表达型患者联用五酯胶囊对他克莫司的日剂量、血药浓度及目标浓度达标时间的影响。结果 共纳入75例患者,糖皮质激素组27例,他克莫司组48例。糖皮质激素组患者达到临床缓解平均时间为(10.6±1.7)周,较他克莫司组的(16.6±1.5)周缩短,但差异无统计学意义(P>0.05);他克莫司组药物相关不良反应发生率低于糖皮质激素组(8.3%比29.6%),差异有统计学意义(P<0.05)。多因素COX回归分析显示,治疗前定量重症肌无力评分>4分(HR=0.203,95%CI:0.065~0.635,P=0.006)、抗乙酰胆碱受体抗体滴度>3.9 nmol/L(HR=0.238,95%CI:0.084~0.677,P=0.007)与达到临床缓解呈负相关;他克莫司血药浓度>6.2 ng/mL(HR=2.697,95%CI:1.172~6.209,P=0.020)与达到临床缓解呈正相关。对CYP3A5基因表达型患者,联合用药组他克莫司日剂量低于单药治疗组[(1.7±0.5)mg比(3.2±0.3)mg],他克莫司血药浓度首次达标时间短于单药治疗组[(1.7±0.4)周比(3.3±0.5)周],差异均有统计学意义(P<0.001),两组他克莫司血药浓度差异无统计学意义(P>0.05)。结论 他克莫司治疗老年眼肌型重症肌无力疗效显著,药物相关不良反应少,对无法应用糖皮质激素的老年患者可能是一种安全、有效的治疗选择。
Objective To investigate the clinical efficacy of tacrolimus in the treatment of ocular myasthenia gravis(OMG)in the elderly.Methods A retrospective analysis was conducted on elderly patients with OMG diagnosed and treated in the Department of Neurology,Beijing Tongren Hospital,Capital Medical University from January 2020 to June 2023.Patients were divided into a glucocorticoid group and a tacrolimus group based on their medication regimen.The clinical efficacy and adverse drug reactions were compared between the two groups.Additionally,the effects of the combined use of wuzhi capsules on a daily dose of tacrolimus,blood concentration,and time to reach the target concentration were analyzed in CYP3A5 expressers in the tacrolimus group.Results A total of 75 patients were included,with 27 cases in the glucocorticoid group and 48 cases in the tacrolimus group.The average time to clinical remission in the glucocorticoid group was(10.6±1.7)weeks,which was shorter than that in the tacrolimus group was(16.6±1.5)weeks,but the difference was not statistically significant(P>0.05).The incidence of adverse drug reactions in the tacrolimus group was lower than that in the glucocorticoid group(8.3%vs 29.6%),with a statistically significant difference(P<0.05).Multivariate COX regression analysis showed that a pre-treatment QMG score>4(HR=0.203,95%CI:0.065 to 0.635,P=0.006),and anti-AChR antibody titer>3.9 nmol/L(HR=0.238,95%CI:0.084 to 0.677,P=0.007)were negatively correlated with achieving clinical remission.A tacrolimus blood concentration>6.2 ng/mL was positively correlated with achieving clinical remission(HR=2.697,95%CI:1.172 to 6.209,P=0.020).For CYP3A5 expressers,the daily dose of tacrolimus in the combined therapy group was lower than that in the monotherapy group[(1.7±0.5)mg vs(3.2±0.3)mg],and the time to first reach the target tacrolimus blood concentration was shorter than that in the monotherapy group[(1.7±0.4)weeks vs(3.3±0.5)weeks],and the differences were statistically significant(P<0.001).There was no significant difference in tacrolimus blood concentration between the two groups(P>0.05).Conclusion Tacrolimus is an effective treatment option for OMG in the elderly with fewer adverse reactions.It may be a safe and effective alternative for elderly patients who cannot tolerate glucocorticoids.
作者
吴京
王佳伟
崔世磊
WU Jing;WANG Jiawei;CUI Shilei(Department of Neurology,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China)
出处
《临床药物治疗杂志》
2024年第8期40-45,共6页
Clinical Medication Journal
作者简介
通信作者:崔世磊,博士,副主任医师,研究方向:神经眼科疾病诊治。E-mail:cslei@163.com。
