摘要
目的探讨胸腺切除术治疗眼肌型重症肌无力(ocular myasthenia gravis,OMG)的疗效及影响因素。方法回顾分析1998-06—2008-06作者医院收治的OMG患者93例,其中行胸腺切除术治疗44例,药物治疗49例。采用Cox比例风险回归模型对患者性别、年龄、术前病程、胸腺病理、术后药物治疗等影响因素进行分析,绘制生存曲线比较手术与药物两种不同治疗方式OMG的转型率及复发率,并进一步比较术后不同病理类型的生存率。结果中位随访时间为60个月。胸腺切除治疗组总有效率68.2%,药物治疗组总有效率32.6%,两组间比较差异有统计学意义(P<0.01)。胸腺病理类型及术后是否使用糖皮质激素与术后疗效显著相关(P<0.05)。胸腺切除术治疗组患者的复发率及转型率较药物治疗组明显降低(均P<0.05),胸腺切除术治疗OMG合并胸腺瘤的生存率较未合并胸腺瘤的患者明显降低(P<0.05)。结论胸腺切除术治疗OMG患者可改善其症状,阻止其向全身型重症肌无力(generalized myasthenia gravis,GMG)转型,是治疗OMG的有效方法。
Objective To assess the prognosis of thymectomy in treatment of ocular myasthenia gravis （OMG） and relevant influencing factors. Methods A total of 93 OMG patients were reviewed in the study. The clinical course and the prognosis were reviewed in 44 patients to whom thymectomy underwent and in 49 with medication. An analysis was studied in comparison of gender, age, dutation of prethymectomy, pathology of thymus and prednisone treatment after thymectomy with Cox regression analysis model. The rate of relapse and the rate of convertion into generalized myasthenia gravis （GMG） were compared between two different treatments for OMG by Kaplan Meier analysis. The survival rates in OMG with thymomas and non-thymomas after thymectomy were further investigated. Results The median follow-up time was 60 months. The effective rate was 68.2 % in the thymectomy group and 32.6 % in the the medication group （P〈0.01）. Cox regression analysis revealed that the prognosis was statistically independent of pathology of thymus （P 〈 0.05） and prednisone treatment （P〈0.05）. The rate of relapse （Log-rank, P〈0.05） and the rate of convertion （Log-rank, P〈0.05） were lower in the thymectomy group than in the medication group. The survival rate in OMG with non-thymomas was higher than OMG with thymomas （Log-rank, P〈0.05）. Conclusions Thymectomy was an effective and safe treatment for OMG which could relieve the symptoms and prevent the progression of OMG to GMG.
出处
《中国神经免疫学和神经病学杂志》
CAS
2009年第2期86-89,共4页
Chinese Journal of Neuroimmunology and Neurology
