重症肌无力患者胸腺切除术后肌无力危象发生风险影响因素的Meta分析  

Factors influencing the risk of myasthenic crisis after thymectomy in myasthenia gravis patients:A meta-analysis

作　　者：吴倩 司玉坤 李君莲 李海燕 胡婉贞 张晓燕 WU Qian;SI Yukun;LI Junlian;LI Haiyan;HU Wanzhen;ZHANG Xiaoyan(不详;*Department of Neurology,the 940 Hospital of Joint Logistic Support Forces of PLA,Lanzhou 730050,China)

机构地区：[1]联勤保障部队第九四〇医院神经内科,730050 [2]菏泽市立医院神经内科,274000 [3]菏泽市定陶区人民医院心胸血管外科,274100

出　　处：《中国神经免疫学和神经病学杂志》2024年第5期383-388,共6页Chinese Journal of Neuroimmunology and Neurology

基　　金：甘肃省科技厅自然科学基金项目(21JR11RA003);院内课题应用基础研究项目(2023YXKY007);兰州市科技计划项目(2023-ZD-175);应用基础研究项目(2022yxky008)。

摘　　要：目的系统分析重症肌无力(myasthenia gravis,MG)患者胸腺切除术后肌无力危象(myasthenic crisis,MC)发生风险的影响因素。方法检索Pubmed、Embase、Cochrane Library、Web of Science、知网、万方数据、中国生物医学文献数据库自建库至2023年11月收录的探讨MG患者胸腺切除术后发生MC相关因素的文献。根据纳入及排除标准进行文献筛选并提取数据,用Rev Man 5.3进行质量评价及meta分析,用Stata 14进行风险偏倚定量分析。结果共30项病例对照或队列研究纳入Meta分析,总样本为5550例。Meta分析结果示:疾病严重程度(OR=6.59,95%CI:4.33~10.01)、经胸骨胸腺切除术式(OR=4.44,95%CI:2.38~8.28)、术中出血量较大(OR=15.52,95%CI:4.64~51.90)、术前延髓肌受累(OR=3.79,95%CI:2.54~5.67)、术前MC史(OR=3.99,95%CI:3.04~5.24)、术后肺部感染(OR=3.34,95%CI:2.08~5.35)、胸腺瘤(OR=2.98,95%CI:1.77~5.01)是MG患者胸腺切除术后发生MC的危险因素。结论MG患者胸腺切除术后发生MC的危险因素较多,术前疾病严重程度较重、累及延髓肌或有MC史、合并胸腺瘤、术式为经胸骨胸腺切除术、术中出血量较大、术后肺部感染是MG患者胸腺切除术后MC发生的独立危险因素。Objective To systematically analyze the factors influencing the risk of myasthenic crisis(MC)in myasthenia gravis(MG)patients after thymectomy.Methods The English or Chinese literature on the risk factors of MC after thymectomy in MG patients were retrieved by computer from inception to November 2023.The database included Pubmed,Embase,Cochrane Library,Web of Science,CNKI,CBM,and Wanfang.Literature screening and data extraction were conducted according to inclusion and exclusion criteria.RevMan 5.3 was used for quality assessment and meta-analysis,and Stata 14 was used for quantitative risk bias analysis.Results A total of 30 case-control or retrospective studies were included in the meta-analysis.The total number of patients was 5550.The results of meta-analysis showed that the severity of the disease(OR=6.59,95%CI:4.33-10.01),transsternal thymectomy(OR=4.44,95%CI:2.38-8.28),the intraoperative blood loss(OR=15.52,95%CI:4.64-51.90),preoperative bulbar symptoms(OR=3.79,95%CI:2.54-5.67),MC history(OR=3.99,95%CI:3.04-5.24),postoperative pulmonary infection(OR=3.34,95%CI:2.08-5.35)and thymoma(OR=2.98,95%CI:1.77-5.01)were risk factors for MC in MG patients after thymotomy.Conclusions There are several risk factors for MC after thymectomy in MG patients.The severity of the disease,especially involving the bulbar symptoms or a history of MC,combined with thymoma,the operative mode of transsternal thymectomy,higher intraoperative bleeding,and postoperative lung infection were independent risk factors for the development of MC after thymectomy in MG patients.

关 键 词：重症肌无力 胸腺切除术 肌无力危象 META分析 

分 类 号：R746.1[医药卫生—神经病学与精神病学]