Study On The Efficacy Of Different Doses Of Glucocorticoid And Intravenous Immunoglobulin In Patients With Myasthenia Gravis

ObjectiveTo explore the comparative analysis of clinical efficacy and adverse reactions of different doses of glucocorticoid and intravenous immunoglobulin in patients with myasthenia gravis.MethodsThe clinical data of 149 cases of MG diagnosed in the department of neurology of our hospital from June 2012 to December 2019 were analyzed retrospectively.According to the different doses of glucocorticoids used during the treatment,they were divided into low-dose glucocorticoid group,high-dose glucocorticoid group and shock-dose glucocorticoid group.The absolute pre-treatment score,clinical efficacy,duration of hospitalization and adverse reactions in different doses of glucocorticoid treatment groups were compared.According to the combined use of immunoglobulin,the patients were divided into two groups: combined treatment group(combined use of immunoglobulin on the basis of glucocorticoid application)and glucocorticoid-along treatment group.The absolute pre-treatment score,clinical efficacy,glucocorticoid dosage,duration of hospitalization and adverse reactions between the two groups and different doses of glucocorticoid groups were compared.ResultsAccording to the different doses of glucocorticoids during treatment,they were divided into low-dose glucocorticoid group,high-dose glucocorticoid group and shock-dose glucocorticoid group.There were significant differences in absolute pre-treatment score among the three groups(12.5±8.5、18.3±10.5、25.8±15.8,P<0.001).The total effective rate among the three groups was 78.6%,84.0% and 88.9%,respectively,and the difference was not statistically significant(χ2=1.256,P=0.534).With the increase of glucocorticoid dosage,the length of hospital stay was 10.6 ±4.8,19.2 ±10.6 and 22.5±7.5,respectively,and the difference was statistically significant(P<0.001).The incidence of aggravation of early transient myasthenia gravis increased with the increase of glucocorticoid dosage,which were 5.4%,12.0% and 33.3%,respectively(χ2=8.471,P=0.014).According to the combination of immunoglobulin,the patients were divided into two groups: combined treatment group and glucocorticoid-along treatment group.The absolute pre-treatment score in the combined treatment group was significantly higher than that in the glucocorticoid-along treatment group(21.7±13.0、12.7±7.3,P<0.001).There was no difference in the total effective rate between the two groups,which were 83.1% and 82.1%,respectively.There was no significant difference in average glucocorticoid dosage and length of stay during hospitalization(P=0.493 and0.355).According to the different doses of glucocorticoids,the combined treatment group was divided into three subgroups: low-dose glucocorticoid subgroup,high-dose glucocorticoid subgroup and shock-dose glucocorticoid subgroup.The absolute pre-treatment score of the three subgroups were significantly different(16.1±10.0,21.8±11.8,39.6±11.3 P <0.001);The total effective rate was 76.9%,83.8% and 100.0%,respectively,was no significant difference between the two groups(χ2=1.914,P=0.388).The length of stay was correlated with the dosage of glucocorticoid,which was 10.7±4.7,20.2 ±11.4,25.8 ±6.9 respectively(P<0.001).According to the different doses of glucocorticoids,glucocorticoid-along treatment group was divided into three subgroups:low-dose glucocorticoid subgroup,high-dose glucocorticoid shock-dose glucocorticoid subgroup.The absolute pre-treatment score of high-dose glucocorticoid subgroup and shock-dose glucocorticoid subgroup were 14.9 ±7.7 and 14.8 ±8.4 respectively,and the difference was no statistically significant(P=1.000).There was no significant difference in the total effective rate between the two groups(χ2=0.000),and the length of hospital stay was 18.1 ±9.7 and 19.4 ±7.0,respectively(P=0.963).Finally,there was no significant difference in the absolute pre-treatment score between low-dose glucocorticoid subgroup in combined group and high-dose glucocorticoid subgroup in glucocorticoid-along treatment group(P=0.844),low-dose glucocorticoid subgroup in combined group and shock-dose glucocorticoid subgroup in glucocorticoid-along treatment group(P=0.981),high-dose glucocorticoid subgroup in combined group and shock-dose glucocorticoid subgroup in glucocorticoid-along treatment group(P=0.148),but the glucocorticoid dosage in combined treatment subgroup was significantly lower than that in glucocorticoid treatment subgroup among the three groups(P<0.05).Conclusion1.For patients with severe MG may require large doses of glucocorticoids and a combination of immunoglobulin.2.For patients with mild MG,glucocorticoid shock therapy may not be applicable.3.Immunoglobulin combined with glucocorticoid therapy can reduce the dosage of glucocorticoid.4.The aggravation of early transient myasthenia gravis is related to the dose of glucocorticoid.