延髓肌型重症肌无力胸腺切除术后疗效及影响因素分析  

Efficacy and influencing factors of thymectomy for bulbar myasthenia gravis

作　　者：张志文 崔新征 郑理想 史宸硕 王猛[1] 杨梦豪 张清勇 Zhang Zhiwen;Cui Xinzheng;Zheng Lixiang;Shi Chenshuo;Wang Meng;Yang Menghao;Zhang Qingyong(Myasthenia Gravis Comprehensive Diagnosis and Treatment Center,People s Hospital of Henan University,Henan Province People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院、河南省人民医院重症肌无力综合诊疗中心,郑州450003

出　　处：《中华胸心血管外科杂志》2024年第9期531-535,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：河南省科技攻关项目(212102310153)。

摘　　要：目的探讨胸腺切除治疗延髓肌型重症肌无力的疗效及其影响因素。方法回顾性收集2018年3月至2023年6月河南省人民医院重症肌无力综合诊疗中心收治的120例延髓肌型重症肌无力患者临床资料,其中男61例,女59例。胸腺瘤患者66例,非胸腺瘤患者54例。术前延髓肌受累病程11天~108个月,术前检测AChR-Ab阳性105例,阴性15例。以延髓肌受累为首发28例,非首发92例。既往发生危象7例,未发生危象113例。采用美国重症肌无力协会的重症肌无力干预后状态评估方案进行术后疗效评估,使用单因素分析和logistic回归分析可能影响手术疗效的因素。结果所有患者均顺利完成胸腺扩大切除术,围手术期无死亡。随访3~57个月,中位随访时间24个月,获得完全持久缓解22例(18.33%),药物维持缓解1例(0.83%),最小症状表现65例(54.17%),改善20例(16.70%),无变化8例(6.67%),无加重病例(0),恶化2例(1.67%),死亡2例(1.67%)。临床缓解23例(19.17%),部分缓解85例(70.83%)。单因素分析结果显示,术前AChR-Ab水平和术前延髓肌受累病程是延髓肌型重症肌无力患者手术疗效的影响因素,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,术前AChR-Ab水平和术前延髓肌受累病程(以<12个月为对照)是手术疗效的独立影响因素。结论胸腺切除治疗延髓肌型重症肌无力可以有效缓解肌无力症状,术前AChR-Ab阳性和延髓肌受累病程较短的患者手术获益更大。Objective:To determine the efficacy and influencing factors of thymectomy for bulbar myasthenia gravis.Methods:The clinical data of 120 patients with bulbar myasthenia gravis admitted to the Myasthenia Gravis Comprehensive Diagnosis and Treatment Center of Henan Provincial People's Hospital from March 2018 to June 2023 were collected,with 61 males and 59 females.There were 66 patients with thymoma and 54 patients with non-thymoma.The duration of bulbar muscle involvement before operation ranged from 11 days to 108 months.Preoperative AChR-Ab was positive in 105 cases and negative in 15 cases.There were 28 cases with bulbar muscle involvement as the initial symptom and 92 cases as the non-initial symptom.There were 7 cases with crisis and 113 cases without crisis in the past.The postoperative efficacy was evaluated according to the Myasthenia Gravis post-treatment status evaluation program of the American Myasthenia Gravis Society.Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the surgical efficacy.Results:All 120 patients successfully underwent extended thymectomy,there was no perioperative death.The follow-up time was 3-57 months,with a median of 24 months.Twenty-two patients(18.33%)achieved complete durable remission,1 patient(0.83%)maintained remission,65 patients(54.17%)had minimal symptoms,and 20 patients(16.70%)improved.No change in 8 cases(6.67%),no aggravation cases(0),deterioration in 2 cases(1.67%),and death in 2 cases(1.67%).23 cases(19.17%)achieved clinical remission and 85 cases(70.83%)achieved partial remission.Univariate analysis showed that positive AChR-Ab before operation and duration of bulbar muscle involvement before operation were the influencing factors of surgical efficacy in patients with bulbar MG,and the difference was statistically significant(P<0.05).Logistic regression analysis showed that positive AChR-Ab before operation and the duration of bulbar muscle involvement before operation were independent influencing factors of surgi

关 键 词：重症肌无力 延髓肌型 治疗效果 影响因素 

分 类 号：R655.7[医药卫生—外科学]