胸腺切除术对重症肌无力患者电生理学指标和临床评分的影响  

The effects of thymectomy on electrophysiological parameters and clinical scores in patients with myasthenia gravis

作　　者：刘银红[1] 许贤豪[1] 崔丽英[2] 秦绍森[1] 王湘[1] 

机构地区：[1]卫生部北京医院神经内科,北京100730 [2]中国医学科学院中国协和医科大学北京协和医院神经内科

出　　处：《中国神经精神疾病杂志》2006年第1期8-10,共3页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的评价胸腺切除术对重症肌无力(MG)的近期疗效。方法对15例MG在胸腺切除术前(平均9天)及术后(平均11天)依次进行了临床绝对评分、右侧腋神经低频重复电刺激(RNS)和右侧伸指总肌单纤维肌电图(SFEMG)检查。结果手术后SFEMG和RNS异常率分别为100%和73%,手术后平均颤抖(jitter)值、异常电位对比例、阻滞电位对比例和临床绝对评分都较手术前有显著的降低;病理为胸腺瘤5例,手术前后平均jitter值、阻滞电位对比例和临床绝对评分均无显著差异,胸腺增生9例,手术后阻滞电位对比例和临床绝对评分较术前显著减低。结论MG患者胸腺切除术后在临床表现和电生理学指标上都有一定程度的改善,但此时大多数患者仍有临床症状和电生理学指标的异常,需要进一步的免疫调节治疗;MG并发胸腺瘤者可能手术后近期疗效差,并发胸腺增生者可能疗效相对较好。Objective To investigate the changes of electrophysiological parameters and clinical scores before and after thymectomy in MG patients, Methods The clinical absolute scores, RNS of right axillary at low rates and SFEMG on right EDC were performed successively on the same day in 15 MG patients on the average of 9 days before and 11 days after thymeetomy. Results The abnormal rate of SFEMG and RNS were 100% and 73% respectively at this time after operation. The mean jitter, the percentage of abnormal and blocking potential pairs, and the clinical absolute scores all decreased significantly after thymectomy. The percentage of blocking potential pairs and clinical absolute scores improved significantly in 9 patients with thymic hyperplasia but in 5 with thymoma after operation. Conclusion Both the clinical situation and electrophysiological parameters improve at some degree the shortly after resection of thymus ; the advanced immunomodulating therapies are needed at next stage because of the majority of MG patients with clinical symptoms and abnormal electrophysiological tests. The MG patients with hyperplasia of thymus may show a better response to thymectomy than those with thymoma.

关 键 词：重症肌无力 胸腺切除术 单纤维肌电图 重复电刺激 临床评分 

分 类 号：R655.7[医药卫生—外科学]