胸腺切除治疗重症肌无力的效果及影响因素分析  

Analysis of the effects and influencing factors of thymectomy for myasthenia gravis

作　　者：庞天宝 黄朋伟 崔新征 陈嘉捷 王梦[1] 赵卫浩 张清勇[1] Pang Tianbao;Huang Pengwei;Cui Xinzheng;Chen Jiajie;Wang Meng;Zhao Weihao;Zhang Qingyong(The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China;Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学第二附属医院胸外科,郑州450014 [2]河南省人民医院重症肌无力综合诊疗中心,郑州450003

出　　处：《中华医学杂志》2019年第41期3232-3236,共5页National Medical Journal of China

基　　金：河南省科技厅科技攻关项目(162102310505)。

摘　　要：目的明确重症肌无力外科治疗的效果及其影响因素。方法回顾2012年8月至2018年9月于郑州大学第二附属医院胸外科和河南省人民医院重症肌无力综合诊疗中心接受胸腺切除术治疗的180例重症肌无力患者临床资料,收集患者的年龄、性别、疾病分型、术前乙酰胆碱受体抗体(AChR-Ab)、术前病程、手术时间、术中出血量、病理类型等数据,采用单因素分析、Cox回归模型分析各种可能影响手术效果的因素。结果纳入研究的患者共145例,随访时间为4~78个月,中位随访时间34个月,获得完全持久缓解(CSR)34例(23.4%),临床缓解达109例(75.1%),有效的达130例(89.6%)。相关性分析结果表明,患者年龄<45岁、术前病程<12个月、术前AChR-Ab阳性、胸腺增生是患者手术效果的几个影响因素,差异有统计学意义,P值分别为0.030、0.048、0.019、0.042。结论胸腺切除治疗重症肌无力安全有效,年龄、术前病程、术前AChR-Ab以及病理类型是手术效果的几个影响因素。Objective To explore the effects of surgical treatment for myasthenia gravis as well as its influencing factors.Methods A total of 180 patients with myasthenia gravis who underwent thymectomy from August 2012 to September 2018 were enrolled.Clinical data such as age,gender,disease classification,preoperative AChR-Ab,preoperative course,operation time,intraoperative blood loss,and pathological type was retrospectively reviewed.Univariate analysis and Cox regression model were used to analyze possible influencing factors of surgical effects.Results A total of 145 patients were finally enrolled and the follow-up period was from 4 to 78 months,with a median follow-up time of 34 months.Thirty-four patients(23.4%)achieved complete stable remission(CSR).The total clinical remission and effective rate reached 75.1%(109 cases)and 89.6%(130 cases),respectively.Correlation analysis showed that age below 45 years old,preoperative course within 12 months,positive AChR-Ab and thymic hyperplasia were clinical influencing factors for better surgical results(P=0.030,0.048,0.019 and 0.042,respectively).Conclusions It is safe and effective to undergo thymectomy for myasthenia gravis.Age,preoperative course,AChR-Ab level and pathological type were the influencing factors of surgical effects.

关 键 词：重症肌无力 胸腺切除术 预后 影响因素 

分 类 号：R74[医药卫生—神经病学与精神病学]