血浆置换在重症肌无力患者围术期的应用及疗效

Application and curative effect of plasma exchange in myasthenia gravis patients with thymectomy

目的:探讨血浆置换在重症肌无力病人胸腺切除术围术期的应用,评价其疗效。方法:回顾性分析我院胸外科胸腺切除术治疗的50例重症肌无力病人的临床资料,所有患者手术前后口服免疫抑制剂、胆碱酯酶抑制剂;其中23例(A组)围术期进行血浆置换,另27例(B组)未进行血浆置换。ELISA法测定两组患者外周血乙酰胆碱受体抗体(acetylcholine receptor antibodies,AChRab)的浓度;比较术后外周血AChRab、临床记分、呼吸辅助时间、肌无力危象发生的差异。结果:A组患者术后AChRab浓度明显下降,且术后1d和1周时A组患者AChRab浓度较B组明显下降(P<0.05),术后1月时两组间差异无统计学意义(P>0.05)。A组患者术后呼吸辅助时间、肌无力危象的发生、术后1周时临床记分较B组差异均有统计学意义(均P<0.05)。结论:血浆置换配合胸腺切除术治疗可明显提高重症肌无力患者近期疗效,是一种安全有效的治疗方法。

Objective To explore the application of plasma exchange in myasthenia gravis（MG）patients with thymectomy,and to evaluate its curative effects.Methods The clinical data of 50 patients with thymectomy were analyzed retrospectively,and the patients were divided into Group A（23 cases,undergoing thymectomy and plasma exchange）and Group B（27 cases,undergoing thymectomy）.The difference of serum concentration of AChRab was examined by ELISA,and the time of auxiliary breath,crisis of myasthenia and clinical evaluation in the 2 groups were compared.Results Serum concentration of AChRab in Group A descended obviously after the plasma exchange.One day and one week after the operation,the AChRab concentration in Group A was obviously lower than that in Group B,but there was no difference one month after the operation.One week after the operation,the time of auxiliary breath,crisis of myasthenia and clinical evaluation in Group A were less than those in Group B.Conclusion Plasma exchange together with thymectomy can improve the temporary curative effects in patients with MG.It is safe and effective for MG.