目的 探讨黄芪注射液联合甲泼尼龙治疗多发性硬化症的临床疗效。方法 选取2014年6月-2015年8月在绵阳市第三人民医院神经内科住院治疗的多发性硬化症患者78例,随机分为对照组和治疗组,每组各39例。对照组静脉滴注注射用甲泼尼龙琥珀酸钠,1.0 g/次加入生理盐水500 mL,1次/d,连续用药5 d后改为口服醋酸泼尼松片,60 mg/次,1次/d,1周后逐渐减量,每5天减10 mg,直至完全停用。治疗组在对照组治疗基础上静脉滴注黄芪注射液,30 mL加入5%葡萄糖溶液250 mL,1次/d。两组患者均连续治疗6周。观察两组的临床疗效,同时比较治疗前后两组Kurtzke扩展致残量表(EDSS)评分、外周血单核细胞(PBMC)平均刺激指数(SI)、IL-23、IL-17的变化情况。结果 治疗后,对照组和治疗组的总有效率分别为74.36%、92.31%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者EDSS评分、SI值、IL-23、IL-17均较治疗前明显降低,同组治疗前后差异有统计学意义(P<0.05);且治疗组这些观察指标的改善程度优于对照组,两组比较差异有统计学意义(P<0.05)。结论 黄芪注射液联合甲泼尼龙治疗多发性硬化症具有较好的临床疗效,可降低血清中IL-23、IL-17水平,并能抑制PBMC增殖活化,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Huangqi Injection combined with methylprednisolone in treatment of multiple sclerosis.Methods Patients (78 cases) with multiple sclerosis in Department of Neurology of the Third Hospital of Mianyang from June 2014 to August 2015 were randomly divided into control (n= 39 ) and treatment (n= 39 ) groups. The patients in the control group were ivadministered with Methylprednisolone Sodium Succinate for injection, 1.0 g added into normal saline 500 mL, once daily. And they were poadministered with Prednisone Acetate Tablets after 5 d, 60 mg/time, once daily. The dosage of Prednisone Acetate Tablets was gradually reduced after one week, minus 10 mg every five days until completely stopped. The patients in the treatment group were ivadministered with Huangqi Injection on the basis of the control group, 30 mL added into 5% glucose solution 250 mL, once daily. The patients in two groups were treated for six weeks. After treatment, the efficacy was evaluated, and the changes of EDSS scores, SI of PBMC, IL-23, and IL-17 in two groups before and after treatment were compared.Results After treatment, the efficacies in the control and treatment groups were 74.36% and 92.31%, respectively, and there were differences between two groups (P < 0.05). After treatment, EDSS scores, SI, IL-23, and IL-17 in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). After treatment, the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05).Conclusion Huangqi Injection combined with methylprednisolone has clinical curative effect in treatment of multiple sclerosis, and can decrease the serum level of IL-23, IL-17, also can inhibit the proliferation and activation of PBMC, which has a certain clinical application value.