免疫抑制剂和抗胆碱酯酶联合治疗眼肌型重症肌无力的疗效观察(附59例分析)

Effect of immunosuppressive and cholinesterase inhibitors in patients with ocular myasthenia gravis:Analysis of 59 cases

目的观察免疫抑制荆和抗胆碱酯酶联合治疗眼肌型包括上睑下垂和眼外肌麻痹而不伴全身症状重症肌无力患者的治疗结果。方法回顾性分析1996年6月至2005年10月在我科就诊的59例眼肌型重症肌无力患者的临床资料。治疗前均行胸腺CT或MRI检查，56例患者予糖皮质激素和抗胆碱酯酶治疗，3例糖皮质激素疗效欠佳或不能用糖皮质激素治疗而改用硫唑嘌呤。随访时间3～5年，平均3．8年。结果痊愈36例（61.02％），基本痊愈22例（37．29％），显效1例（1．69％）。2年后有2例发展为全身型重症肌无力。未见免疫抑制剂严重并发症。结论免疫抑制剂和抗胆碱酯酶联合治疗眼肌型重症肌无力疗效佳，并发症少且轻。

Objective To assess the efficacy of immunosuppressive and cholinesterase inhibitors in reducing diplopia, oc ular motor dysfunction, and ptosis in patients with ocular myasthenia gravis. Methods The records from a clinical data base of 59 patients presenting with ocular myasthenia gravis from June 1996 to October 2005 were reviewed. Fifty-six patients received prednisone and pyridostigmine. Three patients who had contraindications to steroids or who had treatment failure with prednisone received azathioprine. The patients underwent chest computed tomography or nuclear magnetic resonance imaging before treatment. The follow-up duration was 3 5 years （average 3.8 years）. Results Complete remission was achieved in 36 patients （61.02% ）, remission in 22 patients （37.29% ）, and the greatest improvement in one patient （1. 69% ） . Generalized myasthenia gravis occurred in two patients at two years. No patient experienced a major immunosuppressive complication. Conclusion Immunosuppressive and cholinesterase inhibitors is effective treatment and the complications are less and lightly in patients with ocular myasthenia gravis.