眼肌型重症肌无力86例临床分析  

Clinical analysis of 86 patients with ocular myasthenia gravis

作　　者：刘桂琴[1] 申晓丽[1] 周凤[1] 欧阳明[1] 叶琳[1] 

机构地区：[1]暨南大学第二临床医学院深圳市眼科医院,深圳518040

出　　处：《眼科》2010年第6期379-383,共5页Ophthalmology in China

摘　　要：目的分析眼肌型重症肌无力(OMG)的临床特点。设计回顾性病例系列。研究对象2003年10月至2009年10月在深圳市眼科医院就诊的86例OMG患者。方法将OMG依患者发病年龄分为儿童型、早发型和迟发型三型,比较三型OMG间出现上睑下垂、眼外肌功能障碍、眼外肌功能障碍合并眼球突出的出现率以及新斯的明试验、疲劳试验、胸腺CT和甲状腺功能异常的异常率。主要指标上睑下垂、眼外肌功能障碍、眼球突出、新斯的明试验、疲劳试验、胸腺CT和甲状腺功能异常的异常率。结果 91.9%的OMG表现为上睑下垂,其中63%为单眼3、7%为双眼,儿童型、早发型与迟发型OMG上睑下垂的出现率无显著性差异(P>0.05);66.3%的OMG眼外肌功能障碍,其中儿童型OMG眼外肌功能障碍的出现率(27.3%)比早发型(71.8%)和迟发型(92.0%)OMG明显低(P=0.004);17.4%的OMG合并Graves病和甲状腺相关眼病(TAO);三型OMG之间新斯的明试验、疲劳试验和甲状腺功能异常的异常率无显著性差异(P均>0.05)。早发型OMG较少(13.0%)出现胸腺异常(P=0.03)。结论上睑下垂和眼外肌功能障碍是眼肌型重症肌无力的常见临床表现,少数眼肌型重症肌无力可合并Graves病和甲状腺相关眼病。Objective To investigate clinical features of patients with ocular myasthenia gravis （OMG）. Design Retrospective case series. Participants From Oct. 2003 to Oct. 2009, eighty six patients with OMG from Shenzhen Eye Hospital were enrolled. Methods The patients were classified into three types according to onset age： infant, early-onset and delayed OMG. The frequencies of ptosis, abnormal extraocular muscle function, and proptosis combined with abnormal.extraocular muscle function among three types were compared, the abnormal rates of neostigmine test, fatigue test, abnormal CT image in thymus, and abnormal thyroid function among three types were compared. Main Outcome Measures The frequencies of ptosis, abnormal extraocular muscle function, proptosis;the abnormal rates of neostigmine test, fatigue test, abnormal CT image in thymus, and abnormal thyroid function. Results Ptosis was observed in 91.9% of OMG, in which 63% was unilateral and 37% bilateral. There was no significant difference among three groups in frequency of ptosis. Abnormal extraocular muscle function was in 66.3% of OMG. The frequency of abnormal extraocular muscle function in infant OMG （27.3%） was markedly lower than in early-onset （71.8%） and delayed OMG （92.0%） （P=0.004）. 17.4% of OMG patients accompanied with Graves disease （GD） and thyroid associated ophthalmopathy （TAO）. There was no significant difference among three types in abnormal rate of neostigmine test, fatigue test and thyroid function. The abnormal rate of thymus CT image was significantly lower in early-onset OMG （13.0%） than in infant and delayed OMG （P=0.03）. Conclusions Ptosis and abnormal extraocular muscle function were common presentations in OMG. A small part of OMG combined with GD and TAO, demonstrated typical clinical manifestation.

关 键 词：重症肌无力 GRAVES病 甲状腺相关眼病 

分 类 号：R746.1[医药卫生—神经病学与精神病学]