摘要
目的探讨确诊有胸腺病理异常的重症肌无力(myasthenia gravis,MG)患者乙酰胆碱受体(acetylcholine receptor,AchR)抗体与胸腺切除术后肌无力症状改善的相关性及其临床意义。方法回顾性分析接受胸腺切除术治疗的144例MG患者的临床资料。根据胸腺切除术治疗后患者肌无力临床症状改善状况,将患者分为术后无效组(31例)与有效组(113例),并比较2组的临床特征;比较AchR抗体阳性组(95例)与阴性组(49例)患者术后有效率的差异;分析MG患者AchR抗体与胸腺切除术后肌无力症状改善的相关性。结果术后无效组与有效组之间患者年龄、性别、疾病史、疾病分型、发病形式、发病前诱发因素、眼睑下垂与肌力下降症状、诊断性新斯的明实验与重复电刺激、血白细胞计数(WBC)、血沉(ESR)、胸腺病理、治疗药物等特征比较差异无统计学意义(均P>0.05);2组吞咽与呼吸困难症状、C反应蛋白(CRP)、AchR抗体阳性率等特征比较差异有统计学意义(均P<0.05);AchR抗体阳性组与阴性组患者术后有效率分别为69.47%(66/95)与95.92%(47/49),2组比较差异有统计学意义(P<0.001);相关性分析显示AchR抗体与胸腺切除术后肌无力症状改善呈负相关(r<-0.305,P<0.001)。结论胸腺异常合并AchR抗体阳性的MG患者胸腺切除术后肌无力症状改善相对欠佳,两者之间的关系有助于MG患者胸腺切除术的预后判断。
Objective To explore the association between acetylcholine receptor(AchR)antibody and symptom improvement after thymectomy in myasthenia gravis(MG)patients with pathological thymus abnormality.Methods Clinical data of 144 patients who underwent thymectomy for MG were retrospectively analyzed.According to the improvement in clinical symptoms after thymectomy,these patients were divided into ineffective group(31 cases)and effective group(113 cases).Clinical features were compared between the two groups.In addition,the postoperative effective rate was compared between AchR antibody-positive group(95 cases)and AchR antibody-negative group(49 cases).The correlation between AchR antibody and postoperative improvement in MG was analyzed.Results There were no significant differences between ineffective group and effective group in age,gender,disease history,disease classification,onset form,premorbid factors,blepharoptosis,muscle weakness,neostigmine test,repetitive electrical stimulation,white blood cell count,erythrocyte sedimentation rate,thymus pathology and therapeutic drugs(P>0.05).However,differences in dysphagia,dyspnea,C-reactive protein and positive rate of AchR antibody were significant between the two groups(P<0.05).The postoperative effective rate in AchR antibody-positive group(69.47%,66/95)was lower than that in AchR antibody-negative group(95.92%,47/49)(P<0.001).The correlation analysis showed that AchR antibody was negatively correlated with symptom improvement after thymectomy(r<-0.305,P<0.001).Conclusion The improvement in symptoms after thymectomy is relatively poor in MG patients with abnormal thymus and positive AchR antibody,and the association may be helpful to predict the prognosis of thymectomy in MG patients.
作者
王艳秋
欧阳晓春
许国安
张萃萍
熊文娟
WANG Yan-qiu;OUYANG Xiao-chun;XU Guo-an;ZHANG Cui-ping;XIONG Wen-juan(Department of Neurology,No.908 Hospital of the People’s Liberation Army Joint Logistics Support Force,Nanchang 330002,China;Department of Thoracic Surgery,No.908 Hospital of the People’s Liberation Army Joint Logistics Support Force,Nanchang 330002,China)
出处
《南昌大学学报（医学版）》
CAS
2020年第4期46-50,共5页
Journal of Nanchang University：Medical Sciences
基金
南京军区医学科技创新课题(11MA062)。
