胸腺扩大切除术治疗重症肌无力远期疗效及影响因素分析

Long-term efficacy of enlarged thymectomy in treatment of myasthenia gravis and relevant influencing factors:study of 410 cases

目的评价胸腺扩大切除治疗重症肌无力(MG)远期疗效及影响因素。方法对1990年1月至2006年1月在中山大学附属第一医院行胸腺扩大切除术的546例患者进行随访,疗效评价根据临床相对评分法,分为痊愈(缓解)、基本痊愈、显效、好转(以上四项称为有效)和无效。对性别、年龄、病程、临床分型、胸腺病理类型等因素进行统计分析。结果最终随访人数410例,男199例,女211例,术后随访6个月～85个月,平均29个月±18个月。缓解率42.9%,有效率82.3%。Logistic回归显示:术前病程小于1年是影响术后疗效的保护性因素(OR=0.310,P=0.006)。结论术后缓解率及有效率随术后时间延长逐渐上升,患者性别、年龄、临床分型、胸腺病理类型与疗效无关,术前病程越短,术后疗效越好。

Objective To investigate the long-term efficacy of enlarged thymectomy in treatment of myasthenia gravis （MG） and relevant influencing factors. Methods 546 patients with MG underwent enlarged thyrectomy and were followed up for 28 months （6 to 85 months）. Effective follow-up data were obtained from 410 out of the 546 patients. The clinical data of these 410 patients, 199 males and 211 females, were analyzed. Results The remission rate was 42.9% and the effective rate was 82. 3%. Multivariate logistic regression analysis revealed that short duration of preoperative period was an independent factor of the surgical curative effect （odds ratio = 0. 310, P = 0. 006 ） and sex, age, Osserman classification, pathologic type of thymus seemed to be irrelevant to the surgical curative effect. Conclusion Thymectomy is an effective measure for MG and shows a better prognosis in the patients with shorter illness duration.