胸腺切除与药物治疗儿童型重症肌无力疗效分析

Comparative analysis of the clinical outcomes after thymectomy and drug treatment for myasthenia gravis in children

目的比较胸腺切除与药物治疗儿童型重症肌无力(MG)的疗效及影响因素。方法对比分析27例行胸腺扩大切除术及31例经药物治疗的5～14岁儿童型MG患者1年内的治疗效果,并分析不同年龄、性别、病程、临床分型对两种不同治疗方案预后的影响。结果 1年内手术治疗组完全缓解率(48.2%)和总有效率(74.1%)明显高于药物治疗组(分别为19.4%和48.4%,P<0.05)。药物治疗组与手术治疗组中治疗有效的病例在性别构成、病程间比较无统计学差异(P>0.05),而在年龄、临床分型组成间比较有统计学差异(P<0.05)。胸腺切除术后1个月不影响儿童型MG外周血总T、B及自然杀伤淋巴细胞数量。结论胸腺切除治疗儿童型MG的有效率优于单纯药物治疗。在手术治疗有效的病例构成中,以年龄7～10岁、临床类型为Ⅰ型者多见。胸腺手术切除后不影响儿童外周血淋巴细胞数量。

Objective To compare the therapeutic effects of thymectomy and only drug used in the treatment of myasthenia gravis （MG） and relevant factors. Methods A total of 58 children （5-14 years） with MG were followed up for 1 year, including 27 patients with thymectomy and 31 with drug treatment. We compared thymectomy versus drug treatment concerning the rates of remission, improvement, no change and deterioration of peripheral lymphocytes （remission and improvement were regarded as effective）. The association between the outcomes and the factors including age, sex, duration of disease, clinical stage in these two groups were also analyzed. Results The children who underwent thymectomy had significantly greater rate of remission （48.2%） and total efficiency （74.1%） than drug treatment i.e. 19.4% and 48.4%, respectively. Analyzed the effective eases after thymectomy and drug treatment, there were no significant changes of the components of sex and disease duration, while differences in outcomes were associated with ages and clinical stage of patients. There were no changes of peripheral blood T, B and NK cell populations after thymus excised in children. Conclusions In our study, thymectomy in the management of children MG was superior 1o drug treatment regarding clinical effective rate, especially for the children with 7 10 years and clinical stage I. And the populations of periPheral blood lymphocyte did not change after thymectomy performed in children.