目的 :探讨环磷酰胺 (CTX)合并强的松治疗耐受糖皮质激素 (GC)的重症肌无力 (MG)的疗效与安全性。方法 :对 3 0例用甲基强的松龙和地塞米松针剂冲击治疗后减量为强的松 ,维持治疗 1个月效果欠佳的MG患者 ,予CTX0 .2g ,加入生理盐水10 0ml中静脉滴注q3d× 3 0次 ,之后改为 q6d× 15次 ,强的松 60mgqd(晨服 ) ,每周递减 5mg ,减至 2 0mg后维持治疗 1年 ,每次用CTX前后均复查尿常规、肝功能及血常规。结果 :经予治疗后 1年内完全缓解 12例 ,药物缓解 8例 ,显著改善 6例 ,中度改善 2例 ,死亡2例 ,即年内获得疗效良好者 (完全缓解 +药物缓解 +显著改善 ) 2 6例 ,高达 86.7% ,有效 2 8例 ,达 93 .3 % ,4例出现一过性转氨酶升高 ,5例出现白细胞下降 ,3例出现尿蛋白 ,经予对症治疗后均恢复正常 ,无 1例因不良反应而需要停药。结论 :CTX合并强的松治疗耐受GC的MG疗效显著 ,安全 Objective: To investigate the efficacy and safety of cyclophosphamide (CTX) combined with prednisone in the treatment of glucocorticoid-resistant myasthenia gravis (MG). Methods: 30 patients with methylprednisolone and dexamethasone injection shock treatment after the reduction of prednisone, maintenance treatment 1 month MG patients with poor results, to CTX0.2g, added saline 10 0ml In the intravenous infusion of q3d × 3 0 times, then changed to q6d × 15 times, prednisone 60mgqd (morning service), decreasing 5mg per week, reduced to 20mg and maintained for 1 year, before and after each CTX examination urine Routine, liver function and blood routine. Results: In the first year after treatment, complete remission was achieved in 12 cases, drug remission in 8 cases, significant improvement in 6 cases, moderate improvement in 2 cases and death in 2 cases, ie good response was obtained during the year (complete remission + drug remission + significant improvement). 6 cases, up to 86.7%, effective in 28 cases, up to 93.3%, 4 cases of transient transaminase increased in 5 cases of leukopenia, urinary protein in 3 cases, after symptomatic treatment were returned to normal, no 1 case due to adverse reactions and need to stop. Conclusion: CTX combined with prednisone treatment of GC-resistant MG significant effect, safe