不同剂量的甲泼尼龙对脑肿瘤瘤周水肿的临床对照研究-神经外科专业论文.docxVIP

I I 摘 要 目的 通过研究不同剂量的甲泼尼龙（Methylprednisolone ，MP）对脑肿瘤瘤周 水肿(Peritumoral Brain Edema，PTBE)的作用及差异，探讨不同剂量的MP对PTBE 的疗效及安全性，为PTBE的个体化治疗提供有价值的信息。 方法 选取2010年10月至2012年3月期间符合实验要求的69例病例进行前瞻性研 究，随机分为A组（大剂量MP组23例）、B组（常规剂量MP组23例）、C组（对照组 23例），观察各组患者在治疗前后临床神经症状及体征的改善程度，作Karnofsky 表现评分（Karnofsky Performance Score，KPS），并采用头颅MRI测算每个患者 激素治疗前后的水肿指数(Edema Index，EI)，同时观察所有患者在治疗过程中 可能出现的不良反应。 结果 治疗后，A组、B组、C组KPS有效缓解率分别为82.6%，73.9%，52.2%，A组 和C组疗效对比P小于0.05，差异有显著性；显效缓解率为52.2%，17.4%，4.35%， A组与B组、A组与C组比较P均小于0.05，差异具有显著性。A组、B组、C组治疗后， PTBE患者的平均EI分别下降6.77%、5.49%、3.84%；轻度PTBE，只有A组冲击治疗 后，P小于0.05；中、重度PTBE，治疗后A组和B组EI均明显低于治疗前，A组P小 于0.01，B组P小于0.05，都具有统计学意义。短期大剂量MP冲击治疗和常规剂量 MP所产生的不良反应无明显差异。 结论 对于PTBE明显的患者，采用大剂量MP治疗，有效缓解临床症状和水肿带范 围的同时，其不良反应并不明显增加。 关键词 甲泼尼龙，瘤周水肿，水肿指数，KPS，水肿指数 II II Abstract Objective By studying the effect and differences of the different doses of methylprednisolone(MP) on peritumoral brain edema(PTBE) to explore the efficacy and safety of MP, and provide valuable information for the individual treatment of PTBE. Methods Between October 2010 and March 2012, we selected 69 cases that meet the test requirements to study prospectively. We randomly divided the 69 cases into three groups, A group (high-dose MP group, n=23) , group B (conventional dose MP group, n=23), C group (control group, n=23). Through observing the change of every patient’s clinical neurological symptoms and signs in each group before and after treatment, we obtained each patient’s Karnofsky performance score(KPS). At the same time, through the head MRI before and after hormone treatment, we also can obtain each patient’s Edema Index(EI). While we observed every group’s side effects during the treatment. Results After treatment, the effective response rate of group A, group B, group C, were 82.6%, 73.9%, 52.2%, group A compared with group C, P 0.05, the difference is significant; the markedly effective response rates were 52.2%, 17.4%, 4.35%, group A compared with group B, group A compared with group C，P 0.05, the difference