胸腺扩大切除术治疗重症肌无力合并胸腺萎缩的远期疗效及其影响因素分析  

Long-term efficacy and influencing factors of extended thymectomy for myasthenia gravis with thymic atrophy

作　　者：张太明 张小河 沈诚 赵树林 何先东 陶绍霖 谭群友 ZHANG Taiming;ZHANG Xiaohe;SHEN Cheng;ZHAO Shulin;HE Xiandong;TAO Shaolin;TAN Qunyou(Department of Thoracic Surgery,Daping Hospital,Army Medical University,Chongqing,400042,P.R.China;Hebei Provincial Myasthenia Gravis Diagnosis and Treatment Center,Shijiazhuang People Hospital,Shijiazhuang,050030,P.R.China)

机构地区：[1]陆军军医大学大坪医院胸外科,重庆400042 [2]石家庄市人民医院重症肌无力诊疗中心,石家庄050030

出　　处：《中国胸心血管外科临床杂志》2023年第6期848-852,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：重庆市技术创新与应用发展专项(cstc2022ycjh-bgzxm0267)。

摘　　要：目的分析胸腺扩大切除术治疗重症肌无力(myasthenia gravis,MG)合并胸腺萎缩的远期疗效及其影响因素。方法回顾性纳入2014年10月—2018年5月陆军军医大学大坪医院与石家庄市人民医院行胸腺扩大切除术的MG患者,术后病理诊断为胸腺萎缩。分析患者的远期疗效及其影响因素。结果共纳入患者71例,其中男40例、女31例,平均年龄(45.17±12.42)岁。全组患者均顺利完成胸腺扩大切除术。术后完全缓解20例(28.17%),最轻微状态12例(16.90%),改善19例(26.76%),无变化5例(7.04%),加重3例(4.23%),恶化10例(14.08%),死亡2例(2.82%),达标率45.07%,总有效率71.83%。Logistic回归分析提示,MG术前病程[OR=4.61,95%CI(1.13,18.85),P=0.03]、术后溴吡斯的明联用免疫抑制剂[OR=0.12,95%CI(0.03,0.45),P=0.00]是合并胸腺萎缩的MG术后远期疗效的独立影响因素。结论合并胸腺萎缩的MG外科手术可有效缓解MG症状,早期手术有助于提高MG患者远期疗效,术后溴吡斯的明联用免疫抑制剂可改善患者预后。Objective To analyze the surgical efficacy and influencing factors of myasthenia gravis(MG)patients with thymic atrophy after thymectomy.Methods The clinical data of MG patients with thymic atrophy undergoing thymectomy between October 2014 and May 2018 in Daping Hospital of Army Medical University and Shijiazhuang People Hospital were retrospectively analyzed.Results A total of 71 patients were collected,including 40 males and 31 females with a mean age of 45.17±12.42 years.All patients received the surgery successfully.After the surgery,20(28.17%)patients were stable remission,12(16.90%)patients were minimal manifestation status,19(26.76%)patients were improved,5(7.04%)patients showed no change,3(4.23%)patients were worsened,10(14.08%)patients were exacerbated and 2(2.82%)patients were dead.Multivariate logistic regression analysis showed that the preoperative illness duration(OR=4.61,95%CI 1.13-18.85,P=0.03),and postoperative pyridostigmine combined with immunosuppressive(OR=0.12,95%CI 0.03-0.45,P=0.00)were independent risk factors for long-term efficacy of thymectomy for MG patients with thymic atrophy.Conclusion Early surgery after diagnosis of MG and postoperative pyridostigmine combined with immunosuppressive treatment is beneficial to the prognosis of MG patients with thymic atrophy.

关 键 词：重症肌无力 胸腺萎缩 胸腺切除术 远期疗效 

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]