中国神经再生研究(英文版) ›› 2016, Vol. 11 ›› Issue (6): 882-885.doi: 10.4103/1673-5374.184450

• 综述:神经损伤修复保护与再生 • 上一篇    下一篇

甲泼尼龙治疗急性脊髓损伤:一个日益渐强的哲学论战

  

  • 出版日期:2016-06-30 发布日期:2016-06-30

Methylprednisolone for acute spinal cord injury: an increasingly philosophical debate

Christian A. Bowers, Bornali Kundu, Gregory W. J. Hawryluk*   

  1. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
  • Online:2016-06-30 Published:2016-06-30
  • Contact: Gregory W. J. Hawryluk, M.D., Ph.D., gregory.hawryluk@hsc.utah.edu

摘要:

1990年,针对脊髓损伤的治疗似乎终于在第二次全国急性脊髓损伤研究(NASCIS II)的结果公布中出现了。甲泼尼龙琥珀酸钠(MPSS)给药可用于急性脊髓损伤,并立即被誉为一项重大突破,尽管其具有副作用、疗效有限和仅8小时治疗窗的限制。如此巨大并令人兴奋的进步立即让急诊室甚至在NASCIS II完成同行审查符合条件的患者之前就使用了MPSS治疗。自从NASCIS II正式宣布可以使用MPSS以后,针对其疗效是否可靠,给药是否可行的争论就开始了,并一直未得到解决。因为MPSS辩论的双方现在已经对各自理论足够根深蒂固,以至于新的研究无法统一医师意见。一直以来,来自美国犹他大学神经外科系Gregory W. J. Hawryluk教授研究团队认为,脊髓损伤患者在这场辩论中都没有足够的发言权,而患者的意见是在此类临床医生之间的分歧背景下是尤为重要的。文章认为,缺乏对源文献的熟悉程度已经让使用MPSS治疗急性SCI开发数据产生一些误解。并提出,以下参数是值得讨论的: ? 没有证据支持MPSS对急性脊髓损伤有有利作用; ? “损伤后”在8小时时间点做分析; ? NASCIS研究者试图通过呈现单边数据隐藏些什么; ? MPSS给药的弊端证据已经超过其疗效; ? 管理级别的研究证据反对MPSS治疗急性脊髓损伤。直到令人信服的、安全的、有效的适用于脊髓损伤治疗出现,现在至关重要的仍是继续辩论MPSS给药治疗急性脊髓损伤。它讨论的举证责任应该是什么疗法能够治疗这种灾难性疾病,一个可以接受的风险代理以及给予患者多少自主权应该是很重要的。我们的观点是因为涉及到MPSS给药,目前给予脊髓损伤患者的自主性已经不足。

Abstract:

Following publication of NASCIS II, methylprednisolone sodium succinate (MPSS) was hailed as a breakthrough for patients with acute spinal cord injury (SCI). MPSS use for SCI has since become very controversial and it is our opinion that additional evidence is unlikely to break the stalemate amongst clinicians. Patient opinion has the potential to break this stalemate and we review our recent findings which reported that spinal cord injured patients informed of the risks and benefits of MPSS reported a preference for MPSS administration. We discuss the implications of the current MPSS debate on translational research and seek to address some misconceptions which have evolved. As science has failed to resolve the MPSS debate we argue that the debate is an increasingly philosophical one. We question whether SCI might be viewed as a serious condition like cancer where serious side effects of therapeutics are tolerated even when benefits may be small. We also draw attention to the similarity between the side effects of MPSS and isotretinoin which is prescribed for the cosmetic disorder acne vulgaris. Ultimately we question how patient autonomy should be weighed in the context of current SCI guidelines and MPSS’s status as a historical standard of care.

Key words: methylprednisolone, MPSS, steroids, spinal cord injury, debate, philosophy, autonomy, misconceptions