胸腺切除治疗重症肌无力远期疗效及影响因素分析

Long-term outcome after thymectomy for myasthenia gravis and analysis of prognostic factors

目的报道胸腺切除治疗重症肌无力的远期疗效并对影响远期效果的若干因素进行多因素分析。方法回顾1995年1月至1999年12月行胸腺切除的154例重症肌无力患者的病史资料及随访结果,通过logis-tic回归对性别、年龄、术前病程、改良Osserman分型、Besinger评分、胸腺病理、术前激素用量、AchRab和PsmRab水平等因素对术后疗效的影响进行多因素分析。结果中位随访期为7.3(5.3-10.0)年。2例患者在随访期内死亡。152例存活患者在末次随访时有12例(7.9%)达到完全缓解,116例(76.3%)达到部分缓解,12例(7.9%)病情稳定,12例(7.9%)病情加重,总有效率为84.2%。Logistic回归分析表明Besinger评分(回归系数=0.057,P=0.020)和胸腺病理(回归系数=-1.559,P=0.012)与远期疗效显著相关,Besinger评分较高或不伴有胸腺瘤的患者预后较好。结论胸腺切除是治疗重症肌无力的有效手段,Besinger评分和胸腺病理是远期疗效的独立预后因素,Besinger评分较高或不伴有胸腺瘤的患者预后较好。改良Osserman分型与预后的关系需要进一步研究。

Purpose This paper tried to clarify the long-term outcome gravis（MG） and analyze the prognostic factors affecting surgical results. of thymectomy on myasthenia Methods We reviewed the data of 154 myasthenia gravis patients undergone thymectomy between Jan 1995 and Dec 1999. These patients＇ outcome and several clinical features including gender, age, pre-operation duration of MG, modified Osserman Classifieation, Besinger score, pathology of thymus, preoperative dose of prednisone, AchRab and PsmRab titer were evaluated by statistic method. Results The median follow-up period was 7.3（5.3 - 10.0） years. Two patients died during follow-up period. Among the survived 152 patients, 7.9% （12/152） aehieved eomplete remission, 76.3% （116/152） aehieved patial remission, 7. 9%（12/152） kept stable and 7.9% （12/152） deteriorated at the last follow-up. The overall effective rate was 84.2%. Multivariate analysis showed Besinger score（regression coefficient = 0. 057, P = 0. 020） and thymus histology（regression coefficient = - 1. 559, P = 0. 012） were elosely related to patients prognosis. Higher Besinger score or without thymoma predicated a favorate outcome. Conelusions Thymectomy is effective for most myasthenia gravis. Besinger score and pathology of thymus are potential prognostic factors for thymectomized myasthenia gravis. Further study should be carried out to confirm the relationship between modified osserman classification and prognosis.