不同胸腺病理类型重症肌无力的临床特点  

Clinical characteristics of myasthenia gravis with different pathological types of thymus

作　　者：王梦 崔新征 赵卫浩 马文强 张清勇 杨鲲鹏[3] WANG Meng;CUI Xinzheng;ZHAO Weihao;MA Wenqiang;ZHANG Qingyong;YANG Kunpeng(Department of Thoracic Surgery,Zhengzhou People′s Hospital,Zhengzhou 450012;Comprehensive Diagnosis and Treatment Center for Myasthenia Gravis,Henan Provincial People′s Hospital,Zhengzhou 450003;Department of Thoracic Surgery,the Second Affiliated Hospital,Zhengzhou University,Zhengzhou 450014)

机构地区：[1]郑州人民医院胸外科,郑州450012 [2]河南省人民医院重症肌无力综合诊疗中心,郑州450003 [3]郑州大学第二附属医院胸外科,郑州450014

出　　处：《郑州大学学报（医学版）》2021年第6期750-754,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省科技厅科技攻关项目(162102310505,212102310153)。

摘　　要：目的:探讨不同胸腺病理类型重症肌无力(MG)的临床特点。方法:收集2012年8月至2019年7月就诊于郑州大学第二附属医院及河南省人民医院行胸腺切除术的220例MG患者的临床资料,男101例,女119例,术后病理示胸腺瘤104例、胸腺增生44例、胸腺萎缩72例。随访满12个月的患者158例,其中手术有效132例,无效26例。结果:胸腺增生组女性患者较多,93.2%(41/44)为早发型,发病年龄(27.20±15.19)岁。胸腺瘤组发病年龄(48.80±13.35)岁,大于胸腺增生和胸腺萎缩组(P<0.05);呼吸肌受累比例高于其他两组(P<0.05);3组张氏分型差异无统计学意义(P>0.05)。早发型、术前病程<12个月、MG分型全身型、非胸腺瘤型患者术后12个月有效率更高(P<0.05)。以疗效(有效=1,无效=0)为因变量,以MG分型、病理类型为调整因素,Logistic回归分析结果显示,发病类型(早发型为对照)、术前病程(<12个月为对照)是MG胸腺切除术疗效的影响因素,OR(95%CI)分别为0.235(0.085~0.651)、0.159(0.053~0.473)。结论:不同胸腺病理类型MG临床特征不同;手术治疗MG疗效明确,发病年龄、术前病程是手术疗效的影响因素。Aim:To investigate the clinical characteristics of myasthenia gravis(MG)with different pathological types of thymus.Methods:The clinical data of 220 MG patients admitted to the Second Affiliated Hospital of Zhengzhou University and Henan Provincial People′s Hospital for thymectomy from August 2012 to July 2019 were collected;101 males and 119 females;according to postoperative pathology,thymoma 104 cases,thymic hyperplasia 44 cases,and thymic atrophy 72 cases.A total of 158 patients were followed up for 12 months,out of which,132 were effective and 26 were ineffective.Results:In thymic hyperplasia group,females were more common,and 93.2%(41/44)were early-onset,the onset age was(27.20±15.19)years.The onset age of thymoma group was(48.80±13.35)years,higher than those of the other two groups(P<0.05),and the proportion of respiratory muscle involvement was higher than the other two groups(P<0.05);the Zhang′s surgical clinical classification had no differences among the 3 groups(P>0.05).The analysis of 12-month follow-up showed that the patients with early onset,preoperative course<12 months,MG type of systemic type,and non-thymoma type had a higher effective rate(P<0.05).Logistic regression with the efficacy(efficacy=1,inefficacy=0)as the dependent variable,and the pathological type and MG type as the adjusting factors,showed that the preoperative course(<12 months as control)and onset type(early as control)were the influencing factors of thymectomy,OR(95%CI)were 0.235(0.085-0.651)and 0.159(0.053-0.473),respectively.Conclusion:MG with different pathological types of thymus has different clinical features;the effect of surgical treatment of MG is clear,and the onset age,preoperative course are the influencing factors of thymectomy efficacy.

关 键 词：重症肌无力 胸腺病理 胸腺切除术 

分 类 号：R746.1[医药卫生—神经病学与精神病学]