| Objective: To analyze the adverse effects of high dose methylprednisolone(HDMP) in 197 patients who received HDMP treatment 218 times in total. The emphasis is on the incidence and the relative factors.Methods:Retrospective cohort study was used to analyze 218 times of HDMP treatment among 197 patients with neuroimmune diseases in the First Hospital of Jilin University from January, 2010 to November, 2015. Among them, 112 cases of multiple sclerosis, 3 cases of neuromyelitis optica, 36 cases of acute myelitis, 8 cases of myasthenia gravis, 6 cases of Guillain-Barre syndrome, 51 cases of demyelination encephalomyelopathy were included. The incidence of adverse effects in every system was calculated. The patients who experienced adverse effects were compared with the patients who did not experienced side effects on the differences of initial dose, age, gender, diseases and medical history. Statistical analysis was conducted by SPSS Ver.21.0 statistical software.Results: In 216 times of high dose methylprednisolone treatment, there are 78 cases experienced none of the adverse effects. The total incidence of adverse effects is 63.89%. Mental abnormality including anxiety, depression and poor sleep quality was found in 28 cases, account for 12.96% of all cases. Infection including new infection and spread of primary infection after HDMP treatment was found in 23 cases, account for 10.65% of all cases. Gastrointestinal symptoms such as diarrhea, vomit and stomach upset was found in 21 cases, account for 9.72% of all cases. Nine cases experienced cardiopalmus, account for 4.17% of all cases. Elevation of blood pressure was found in 8 cases, account for 3.70% of all cases. There are 15 patients who suffered from hot flash, which account for 6.94% of all cases. Swelling and hip pain each happened in 5 cases, which account for 2.31% each. Three patients experienced rash, account for 1.39% of all cases. Profuse sweating and general weakness each happened in 2 cases of all, account for 0.93% of all cases each. 9 cases did electrocardiogram examination again after HDMP treatment, and 5 of them developed arrhythmia. 22 cases did liver function test after HDMP treatment, the abnormal liver function was found in 11 of them. 56 cases measured blood glucose level again after HDMP treatment. Among the cases who had no history of diabetes and whose blood glucose level was normal before the treatment, blood glucose level slightly elevated in 11 cases and significantly elevated in 5 cases. There were 10 cases who had diabetes, the reexamination of blood glucose level after HDMP showed that the blood glucose of all the 10 cases was elevated. 97 cases tested serum potassium concentration again after HDMP treatment, hypokalemia was found in 16 of them. 95 cases measured the level of serum natrium(Na), chlorine(Cl) and calcium(Ca) concentration again after HDMP treatment. Hyponatremia occurred in 37 cases including 2 cases whose serum sodium concentration below 130mmol/l. Hypochloremia occurred in 36 cases. Hypocalcemia occurred in 30 cases. Ninety cases did blood routine tests again after HDMP treatment, elevated white blood cell which was speculated caused by HDMP treatment was found in 45 cases. Severe side effects including one case of heart failure and one case of pulmonary embolism, account for 0.93% in all cases.Conclusion: 1. The incidence of severe adverse effects of high dose methylprednisolone is low according to this study, which shows that high dose methylprednisolone treatment is relative safe. 2. The two groups of patients with initial dose of 1000 mg and 500 mg methylprednisolone, the 1000 mg methylprednisolone group is more easily suffer from the adverse effects of infection. In addition to this, the incidence of adverse effects in the two groups showed no difference. 3. The adverse effects had no correlation with diseases, gender, age and the dysfunction of autonomic nervous system. 4. The patients with history of diabetes, hypertension or heart disease should be evaluated before high dose methylprednisolone treatment. The blood pressure, blood glucose level and serum level of ions and other accessory examinations of the patients should be monitored during the treatment. |
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