眼肌型重症肌无力的临床和电生理研究

Clinical and electrophysiological study on ocular myasthenia gravis

目的探讨眼肌型重症肌无力(ocular myastheniagravis,OMG)的临床表现、辅助检查及电生理特征,为临床诊断提供帮助。方法对63例OMG患者的临床资料、辅助检查和电生理特征进行回顾性研究。结果OMG主要表现为单侧(占31.7%)或双侧(占68.3%)上睑下垂,眼球垂直(占19.0%)与水平(占22.2%)运动障碍,眼球固定(占1.6%)。OMG重复神经电刺激(repetitive nerve stimulation,RNS)异常率为54.0%,单纤维肌电图(single fiber electromyography,SFEMG)异常率为58.7%。OMG乙酰胆碱受体抗体(AchRAb)滴度增高占28.6%,并发甲亢为14.3%,心肌酶学异常为17.5%,胸腺瘤阳性率为3.2%,胸腺增生为41.3%。结论OMG多表现为眼睑下垂和眼球活动障碍。辅助检查中,AchRAb阳性率低,胸腺增生常见,胸腺瘤少见,以电生理检查阳性率最高,有助于OMG的诊断。

Objective To study the. clinical features, auxiliary examination and electrophysiology in diagnosis of ocular myasthenia gravis. Methods Sixty pafients with ocular myasthenia gravis （OMG） were retrospectively analyzed based on the clinical data, auxiliary examination and electrophysiology. Results Critical manifestations of OMG were. lapsus palpebrae superioris in unilateral（31. 7% ） or bilateral（68.3% ） eyelids, vertical（19.0% ） or horizontal（22.2% ） eyeball movement disorder and eyeball fixation disorder （1.6 % ）. Repetitive nerve electric stimulation showed abnormal in 54.0 % of the cases. Single fiber electromyogram in common extensor muscle of digits was abnormal in 58.7% of the cases. An increaes in acetylcholine receptor antibody （AchRAb） was detected in 28.6% of cases. Hyperthyroidism was found in 14.3% of the cases and abnormality of mynoardial enzymes found in 17.5% of the cases. Thymorma was found in 3.2% of the. cases and thymic hyperplasia in 41.3 % of the caese. Condusion The commonest manifestotion of OMG includes ptosis and eyeball movement ld say： paralysis. AchRAb positive rate and thymoma are rare. and thymic hyperplasia is common. Abnormal electropbyslology is common and helpful for the diagnosis of OMG.