早期免疫抑制治疗在预防眼肌型重症肌无力向全身型转化中的作用  

Effect of early immunotherapy in preventing conversion of ocular myasthenia gravis to generalized myasthenia gravis

作　　者：阮哲 宁凡 苏悦 常婷 屈秋民[1] RUAN Zhe;NING Fan;SU Yue;CHANG Ting;QU Qiumin(Department of Neurology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Neurology,The Second Affiliated Hospital of Air Force Military Medical University,Xi’an 710038,China)

机构地区：[1]西安交通大学第一附属医院神经内科,陕西西安710061 [2]空军军医大学第二附属医院神经内科,陕西西安710038

出　　处：《西安交通大学学报（医学版）》2024年第2期312-319,共8页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家重点研发计划资助项目(No.2022YFC3501303)。

摘　　要：目的比较眼肌型重症肌无力(OMG)患者接受或不接受免疫抑制治疗的全身转化风险。方法回顾了2015年1月1日至2019年5月1日在空军军医大学唐都医院注册登记的OMG患者的资料,按照是否接受免疫抑制治疗将患者分为治疗组和对照组,使用多因素Cox比例风险回归模型分析比较了发病后2年内两组患者的疾病转化风险。通过敏感性分析,评估了免疫抑制治疗时程以及不同免疫治疗方案下的转化风险;使用分层分析,评价了不同亚组因子水平下主要结果的一致性。结果共收集702例以眼肌症状起病的重症肌无力(MG)患者的信息,367例(52.3%)患者被纳入治疗组,平均发病年龄为(50.54±15.1)岁,其中159例(43.3%)为女性。335例(47.7%)患者被纳入对照组,平均年龄(49.1±14.6)岁,159例(47.5%)为女性。治疗组中28例(7.7%),对照组中106例(31.6%)患者在观察期内转化为全身型重症肌无力(GMG)。经多变量校正的Cox模型分析后发现,与对照组相比,接受免疫抑制治疗的患者全身转化风险明显降低(HR=0.24;95%CI:0.15~0.37;P<0.001)。敏感性分析发现,免疫抑制持续时间越长,转化风险越低(HR=0.88;95%CI:0.85~0.91;P<0.001)。分层分析显示,不同亚组中患者接受免疫抑制治疗均可降低转化风险。结论早期接受免疫抑制治疗可以显著降低OMG患者向全身型转化的风险。Objective To compare the risk of generalization in patients with ocular myasthenia gravis(OMG) receiving or not receiving immunosuppressive treatment.Methods The data of patients with OMG registered in Tangdu Hospital of Air Force Military Medical University from January 1,2015 to May 1,2019 were reviewed;the patients were divided into treatment group and control group according to whether they had received immunosuppressive treatment.The multivariate Cox proportional hazards regression model analysis was used to compare the risk of generalization between the two groups of patients within 2 years of onset.Sensitivity analysis was used to evaluate the duration of immunosuppressive treatment and the risk of generalization under different immunotherapy regimens.By using stratified analysis,the consistency of the main results across different levels of subgroup factors was evaluated.Results A total of 702 OMG patients were collected.Of them 367 patients(52.3%) were included in the treatment group,with an average onset age of(50.54±15.1) years,and 159(43.3%) being female.Another 335 patients(47.7%) were included in the control group,with an average age of(49.1±14.6) years,and 159 ones(47.5%) were female.A total of 28 cases(7.7%) in the treatment group and 106 cases(31.6%) in the control group developed generalization during the observation period.After multivariate-adjusted Cox model analysis,patients who had received immunosuppressive treatment had a significantly lower risk of generalization compared with the control group(HR=0.24;95% CI:0.15-0.37;P<0.001).Sensitivity analysis found that the longer the duration of immunosuppression,the lower the risk of generalization(HR=0.88;95% CI:0.85-0.91;P<0.001).Stratified analysis showed that immunosuppressive therapy reduced the risk of generalization in different subgroups of patients.Conclusion Early immunosuppressive treatment can significantly reduce the risk of generalization in patients with OMG.

关 键 词：眼肌型重症肌无力(OMG) 全身型重症肌无力(GMG) 全身转化 免疫治疗 

分 类 号：R746.1[医药卫生—神经病学与精神病学]