非瘤性重症肌无力患者胸腺切除的疗效分析  

Efficacy of thymectomy in patients with non-thymoma myasthenia gravis

作　　者：杨松 还逍[1] 闫翀 宋捷 罗苏珊 卢家红 赵重波 Yang Song;Huan Xiao;Yan Chong;Song Jie;Luo Sushan;Lu Jiahong;Zhao Chongbo(Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Neurology,the Third Affiliated Hospital of Soochow University(Changzhou First People′s Hospital),Changzhou 213003,China)

机构地区：[1]复旦大学附属华山医院神经内科,上海200040 [2]苏州大学附属第三医院(常州市第一人民医院)神经内科,常州213003

出　　处：《中华医学杂志》2020年第29期2297-2302,共6页National Medical Journal of China

摘　　要：目的比较非胸腺瘤性全身型重症肌无力(MG)患者胸腺切除联合泼尼松与单用泼尼松治疗的效果差异。方法从复旦大学附属华山医院重症肌无力数据库(2005年至今)中筛选30例行胸腺切除且病理除外胸腺瘤的全身型MG患者为手术组,匹配39例非手术患者作为对照组。以入组时间为起点,以病情"临床缓解",包括完全稳定缓解(CSR)、药物缓解(PR)和最小表现(MM)为终点事件,利用生存曲线比较两组患者终点事件发生时间的差异;随访12个月,对两组患者的部分临床指标进行比较。结果两组患者终点事件发生时间差异无统计学意义(P=0.614)。随访6个月,两组患者的病情临床缓解率、溴吡斯的明和泼尼松用量以及泼尼松峰值用量、其他免疫制剂使用率、病情恶化住院率比较差异均无统计学意义(均P>0.05)。随访12个月,手术组患者泼尼松和溴吡斯的明用量[M(Q1,Q3)]均小于对照组[5(0,10)mg/d,30(0,105)mg/d比7.5(5,10)mg/d,90(15,180)mg/d],差异有统计学意义(P=0.038、0.032)。结论对于轻、中度非胸腺瘤性全身型MG患者,胸腺切除不能使病情更快缓解,但可减少远期泼尼松和溴吡斯的明用量。Objective To compare the efficacy between thymectomy plus prednisone and prednisone alone in patients with non-thymoma myasthenia gravis (MG).Methods Thirty generalized MG patients without thymoma who underwent thymectomy were collected as the operation group, and thirty-nine patients without thymectomy who were treated with prednisone alone were matched as the control group. The start point was the enrollment time and the endpoint event was the "clinical remission" (including complete stabilization remission, drug remission, and poor performance). The survival curve was used to analyze the difference of endpoint event time between the two groups. Besides, a 12-month follow-up study was conducted to compare relevant clinical indicators between the two groups.Results There was no significant difference in the occurrence time of endpoint events between the two groups (P=0.614). After 6-month follow-up, no significant differences were found in clinical remission rate, the dosage of pyridostigmine bromide and prednisone, the peak dosage of prednisone, the use of other immunosuppressive medications and the rate of hospitalization for exacerbation of disease between the two groups (all P>0.05). After 12-month follow-up, the dosage of prednisone and pyridostigmine in the operation group was significantly lower than that in the control group (5(0,10)mg/d vs 7.5(5,10)mg/d and 30(0,105)mg/d vs 90(15,180)mg/d;P=0.038, 0.032).Conclusion In patients with mild to moderate non-thymoma generalized MG, thymectomy does not achieve faster remission, but it does reduce the long-term dosage of prednisone and bromopyrazine.

关 键 词：重症肌无力 胸腺切除术 泼尼松 

分 类 号：R655.7[医药卫生—外科学]