重症肌无力胸腺切除术后缓解与复发的临床观察  

An observational study on remission and recurrence of myasthenia gravis after thymectomy

作　　者：李文文 李然[1] 刘欣欣[1] 景筠[1] LI Wenwen;LI Ran;LIU Xinxin;JING Yun*(Department of Neurology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院神经内科,100730 [2]北京市中关村医院

出　　处：《中国神经免疫学和神经病学杂志》2020年第1期9-14,共6页Chinese Journal of Neuroimmunology and Neurology

基　　金：北京市科委首都临床特色应用研究专项项目支持（项目编号：Z181100001718151）

摘　　要：目的探讨伴与不伴胸腺瘤重症肌无力(MG)患者胸腺切除术后预后结局的差异,分析其预后因素。方法收集2017年9月至2018年12月在作者医院行胸腺切除术的MG 67例,比较伴与不伴胸腺瘤MG患者术后不同时间节点理想状态率、复发率的差异,并分析影响预后的因素。结果 (1)非胸腺瘤-MG术后1、6、12个月与胸腺瘤-MG术后6、12个月肌力评分均较术前明显降低(P<0.05)。(2)非胸腺瘤-MG术后理想状态率1个月(5.6%)、6个月(31.1%)、12个月(54.8%)及胸腺瘤-MG术后1个月(0%)、6个月(23.1%)、12个月(42.9%)均逐渐上升,两组间比较无统计学差异。早手术(起病-手术间期<6个月)、眼肌型是MG患者术后达到理想状态的有利因素,OR(95%CI)分别为4.211(1.146~15.475)、4.813(1.430~16.203)。(3)非胸腺瘤-MG术后复发率1个月(3.7%)、6个月(33.3%)、12个月(54.8%)及胸腺瘤-MG术后1个月(30.8%)、6个月(30.8%)、12个月(57.1%)逐渐上升,两组间比较仅第1个月的差异有统计学意义(P<0.05)。手术-复发间隔时间较短者多见于乙酰胆碱受体抗体(AChR-Abs)强阳性(≥20nmol/L)MG及胸腺瘤-MG(P=0.038,P=0.001)。结论对具有一定适应证的MG患者早期行胸腺切除有助于提高理想状态率;AChR-Abs强阳性、胸腺瘤-MG患者术后早期复发风险大;伴或不伴胸腺瘤-MG术后远期预后无统计学差异。Objective To explore the difference in outcome between patients with myasthenia gravis(MG)with and without thymoma after thymectomy and to analyze the predictive factors.Methods A total of 67 MG patients who underwent thymectomy in our hospital from September 2017 to December 2018 were enrolled in this study,including 32(47.8%)females,41(61.2%)with ocular type(OMG),13(24.1%)with thymoma,52(85.2%)with AChR-Abs,and 9(13.4%)without AChR-Abs.The age range at the time of surgery was 15-67 years.SPSS22.0 software was used to compare the difference in ideal status(i.e.minimal manifestations and better status in MGFA postintervention status)and recurrence rates between MG patients with and without thymoma at different time points after surgery,and to analyze the prognostic factors for different prognostic outcomes.Results (1)Quantitative Myasthenia Gravis score(QMGs)at 1,6 and 12 months post operation in non-thymoma-MG patients and QMGs at 6 and 12 months after operation in thymomaMG patients were significantly lower those before operation(P<0.05).(2)The ideal condition rates of nonthymoma-MG group at 1 month(5.6%),6 months(31.1%)and 12 months(54.8%)after operation and the ideal condition rates of thymomas-MG group at 1 month(0%),6 months(23.1%)and 12 months(42.9%)after operation showed a trend of gradual increase,and there was no significant difference between the two groups.Early operation(onset-operation interval< 6 months)and ocular type were the favorable factors for MG patients to achieve the ideal postoperative status,ORS(95%CI)were 4.211(1.146-15.475)and 4.813(1.430-16.203),respectively.(3)The recurrence rates of the non-thymoma-MG group at 1 months(3.7%),6 months(33.3%),and 12 months(54.8%)after the operation,as well as the recurrence rates of thymoma-MG group at 1 month(30.8%),6 months(30.8%),and 12 months(57.1%)after the operation,showed a gradually increasing trend.The difference between the two groups was statistically significant only in the first month.Patients with shorter interval between surgery and rec

关 键 词：重症肌无力 胸腺瘤 胸腺切除 预后 复发 

分 类 号：R746.1[医药卫生—神经病学与精神病学]