重症肌无力胸腺切除术后发生肌无力危象危险因素的Meta分析  

Risk Factors of Myasthenic Crisis after Thymectomy for Patients with Myasthenia Gravis:A Meta-analysis

作　　者：钱昆杰 张力为[2] 李德生[2] 居来提.艾尼瓦尔 伊力亚尔.夏合丁 孙清超[2] 

机构地区：[1]石河子大学医学院第一附属医院胸心外科,新疆石河子832003 [2]新疆医科大学第一附属医院胸外科,乌鲁木齐830054

出　　处：《中国循证医学杂志》2016年第7期788-794,共7页Chinese Journal of Evidence-based Medicine

摘　　要：目的探讨重症肌无力胸腺切除术后发生肌无力危象的危险因素。方法计算机检索PubMed、EMbase、The Cochrane Library(2015年8期)、Web of Knowledge、CBM、WanFang Data和CNKI数据库,搜集国内外有关重症肌无力胸腺切除术后发生肌无力危象的相关病例-对照研究和回顾性队列研究,检索时限均从建库至2015年8月。由2位研究者独立筛选文献,提取资料并评价纳入研究的偏倚风险后,采用Stata 13.0软件进行Meta分析。结果共纳入17个研究,包括11个回顾性队列研究和6个病例-对照研究,累计病例组394例,对照组1 642例。Meta分析结果显示:1单因素分析显示,肌无力危象史[OR=8.05,95%CI(5.80,11.15),P<0.01],延髓支配肌肌无力[OR=5.10,95%CI(3.01,8.67),P<0.01],肌无力严重程度(Osserman分型)[OR=10.55,95%CI(7.28,15.30),P<0.01],术后肺部感染[OR=10.77,95%CI(3.88,29.95),P<0.01],胸腺瘤[OR=2.37,95%CI(1.50,3.75),P<0.01],吡斯的明服用剂量[MD=0.45,95%CI(0.29,0.62),P<0.01],血清乙酰胆碱受体抗体>100 nmol/L[OR=12.14,95%CI(4.80,30.73),P<0.01]和手术时间[MD=0.57,95%CI(0.26,0.88),P<0.01]是重症肌无力胸胸腺切除术后肌无力危象的危险因素;2多因素分析显示,肌无力危象史[OR=5.06,95%CI(2.30,11.14),P<0.01]、延髓支配肌肌无力[OR=5.21,95%CI(2.62,10.35),P<0.01]、肌无力严重程度(Osserman分型)[OR=5.82,95%CI(2.60,13.04),P<0.01]和血清乙酰胆碱受体抗体>100 nmol/L[OR=8.38,95%CI(3.31,23.08),P<0.01]是重症肌无力胸腺切除术后肌无力危象的独立危险因素。结论重症肌无力胸腺切除术后发生肌无力危象的危险因素较多,肌无力危象史、延髓支配肌肌无力、肌无力严重程度和血清乙酰胆碱受体抗体>100 nmol/L是重症肌无力患者胸腺切除术后发生肌无力危象的独立危险因素。Objective To explore the risk factors of myasthenic crisis after thymectomy （MCAT） for patients with myasthenia gravis （MG）. Methods We searched PubMed, EMbase, The Cochrane Library （Issue 8, 2015）, Web of Knowledge, CBM, CNKI and WanFang Data from inception to August 31, 2015, to collect case-control studies and retrospective cohort studies about the MCAT for patients with MG. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 13.0 software. Results A total of 17 studies involving 394 patients with myasthenic crisis and 1 642 controls were included. Of the 17 studies, 11 were retrospective cohort studies and 6 were case-control studies. The results of meta-analysis showed that： a） univariate analysis indicated that history of myasthenic crisis （OR=8.05, 95%CI 5.80 to 11.15, P〈0.01）, bulbar symptoms （OR=5.10, 95%CI 3.01 to 8.67, P〈0.01）, preoperative severity of gravis （Osserman-stage） （OR=10.55, 95%CI 7.28 to 15.30, P〈0.01）, postoperative pulmonary infection （OR--10.77, 95%CI 3.88 to 29.95, P〈0.01）, thymoma （OR=2.37, 95%CI 1.50 to 3.75, P〈0.01）, dose of pyridostigmine （MD=0.45, 95%CI 0.29 to 0.62, P〈0.01）, AChRAb level〉100 nmol/L （OR=12.14, 95%CI 4.80 to 30.73, P〈0.01） and operation time （MD=0.57, 95%CI 0.26 to 0.88, P〈0.01） were the risk factors of MCAT; b） multivariate analysis showed that, history of myasthenic crisis （OR=5.06, 95%CI 2.30 to 11.14, P〈0.01）, bulbar symptoms （OR=5.21, 95%CI 2.62 to 10.35, P〈0.01）, preoperative severity of gravis （Osserman-stage）（OR=5.82, 95%CI 2.60 to 13.04, P〈0.01） and AChRAb level〉 100 nmol/L （OR=8.38, 95%CI 3.31 to 23.08, P〈0.01） were the independent risk factors of MCAT. Conclusion The independent risk factors of MCAT for patients with MG are history of myasthenic crisis, bulbar symptoms, preoperative severity of gravis （Osserman-stage） and AChRAb level〉 100 nm

关 键 词：胸腺切除 重症肌无力危象 危险因素 系统评价 META分析 病例-对照研究 

分 类 号：R746.1[医药卫生—神经病学与精神病学] R655.7[医药卫生—临床医学]