胸腺摘除对眼肌型重症肌无力疗效及影响因素分析  

Prognosis of thymectomy in treatment of ocular myasthenia gravis and relevant influencing factors

作　　者：邓艳[1] 张旭[1] 

机构地区：[1]温州医学院附属第一医院神经内科,325000

出　　处：《中华医学杂志》2009年第27期1922-1925,共4页National Medical Journal of China

摘　　要：目的探讨胸腺摘除术对眼肌型重症肌无力（OMG）疗效及影响因素分析。方法回顾从1998年6月至2009年3月接受治疗的OMG患者135例，其中胸腺摘除术治疗65例，药物治疗70例。绘制生存曲线比较两种不同方式治疗OMG的转型率及复发率；采用COX比例风险回归模型对性别、年龄、术前病程、AChR Ab、Titin Ab、胸腺病理、术后激素治疗等影响因素进行分析，进一步比较Titin Ab水平、不同胸腺病理类型术后的复发率及转型率。结果中位随访期为62个月。胸腺摘除治疗组总有效率72．3％，药物治疗组总有效率34．3％，差异有统计学意义（P〈0．01）。Titin Ab水平、胸腺病理及术后是否使用激素与术后疗效显著相关（均P〈0．05）。Titin Ab阳性及合并胸腺瘤的患者术后复发率及转型率明显高于Titin Ab阴性及不伴胸腺瘤患者（P〈0．05）。结论胸腺摘除术是治疗OMG的有效手段，可改善症状，阻止复发及向全身型重症肌无力（GMG）转型。Objective To assess the prognosis of thymectomy in treatment of ocular myasthenia gravis （OMG） and relevant influencing factors. Methods A total of 135 OMG patients were included. The clinical course and the prognosis were reviewed in 65 patients with thymectomy and in 70 with medication. We compared the rate of relapse and conversion into generalized myasthenia gravis （ GMG ） between two different treatments for OMG by Kaplan-Meier analysis. An analysis of COX regression model was employed to compare gender, age, duration of prethymectomy, acetylcholine receptor antibody （AChR Ab）, anti-titin antibody （Titin Ab）, thymus pathology and postthymectomy prednisone. The rates of relapse and conversion in OMG with thymomas or non-thymomas and with Titin Ab positive or negative after thymectomy were further investigated. Results The median follow-up was 62 months, The effective rate was 72. 3% in the thymectomy group and 34. 3% in the medication group （ P 〈 0.01 ）. The COX regression analysis revealed that the prognosis was statistically independent of Titin Ab （ P 〈 0. 05 ） , thymus pathology （ P 〈 0. 05 ） and prednisone treatment （ P 〈 0. 05 ）. The rate of relapse （ Log-Rank, P 〈 0. 05 ） and the rate of conversion （ Log-Rank, P 〈 0.05 ） were smaller in the thymectomy group than in the medication groups. The rates of relapse and conversion in OMG with Titin Ab positive or thymomas were higher than OMG with Titin Ab negative or non-thymomas （ Log-Rank, P 〈 0. 05）. Conclusion As an effective and safe treatment for OMG, thymectomy can relieve the symptoms and prevent the progression of OMG to GMG.

关 键 词：重症肌无力 胸腺切除术 预后 

分 类 号：R686[医药卫生—骨科学]