Abstract: Objective To formulate the best treatment plan for multiple sclerosis (MS) patients by evaluating the therapeutic efficacy and side effect of various evidence-based programs. Methods Key words were defined as multiple sclerosis, immunomodulatory therapy and therapy, etc. We searched MEDLINE, Cochrane Library, Wanfang data bases for Scientific Journals in China and National Knowledge Infrastructure for Chinese Scientific Journals Database. Additionally, we applied manual searching and screened out conference paper and academic dissertation, etc, from various references. After that we obtained and evaluated by Jadad scales on systematic reviews, randomized controlled trials, controlled clinical trials and observational study cases about glucocorticoids, plasmapheresis, intravenous immunoglobulin, IFN-β, glatiramer acetate, mitoxantrone, natalizumab, fingolimod. Results After screening, all seventeen selected resources included systematic reviews 6 articles, randomized controlled trials 7 articles, controlled clinical trials 2 articles, observational study cases 2 articles, among which fifteen articles were proved to be high quality (according to Jadad scoring system, five score 4, six score 5, four score 7), two chapters were judged to be low quality scoring 3. Finally, we summerize that: 1) The first choice of treatment for acute relapses is glucocorticoids and we suggest that plasmapheresis or intravenous immunoglobulin may be tried as an alternative therapy in acute MS relapse, especially in case of contraindications to intravenous methylprednisolone. 2) Immunomodulatory or immunosuppressive treatment (IFN-β, glatiramer acetate, mitoxantrone, natalizumab) can be an option to prevent new relapses and progression of disability. 3) Fingolimod is an oral treatment for multiple sclerosis to improve treatment adherence. Conclusion Using evidence-based medicine methods can provide us best clinical evidence on MS treatment.

Key words: Multiple sclerosis, Immunologic factors, Glucocorticoids, Evidence-based medicine

摘要： 目的 评价不同治疗方案对多发性硬化的疗效及不良反应，从循证医学角度为制定最佳治疗方案提供依据。方法 以多发性硬化、免疫调节、治疗等词组作为检索词，分别检索MEDLINE、Cochrane 图书馆、万方数据知识服务平台学术期刊库和中国知网中国期刊全文数据库并辅助手工检索，获取有关糖皮质激素、血浆置换、静脉注射免疫球蛋白、干扰素-β、醋酸格拉默、米托恩醌、那他珠单抗及芬戈莫德等治疗药物或方法的系统评价、随机对照临床试验、临床对照试验及病例观察研究，采用Jadad量表对文献质量进行评价。结果 经筛选共纳入与多发性硬化治疗有关的系统评价6 篇、随机对照临床试验7 篇、临床对照试验2 篇、病例观察研究2 篇。其中15 篇评为高质量文献，评分分别为4 分（5 篇）、5 分（6 篇）和7 分（4 篇）；2 篇为低质量文献，评分3 分。根据对各种治疗方法的疗效及安全性评价显示：（1）糖皮质激素为多发性硬化急性复发时的首选治疗药物，病情不能缓解的患者应以血浆置换或静脉注射免疫球蛋白作为替代治疗。（2）干扰素-β、醋酸格拉默可以作为多发性硬化缓解期治疗的一线药物，若无效可以米托恩醌、那他珠单抗作为二线治疗药物。（3）芬戈莫德作为多发性硬化缓解期治疗的口服药物，有利于提高患者的依从性。结论 借助循证医学的方法可为多发性硬化患者的治疗提供最佳临床证据。

关键词: 多发性硬化, 免疫因子类, 糖皮质激素类, 循证医学