眼肌型重症肌无力治疗措施的临床证据

Clinical Evidence of Treatment for Ocular Myasthenia Gravis

目的为眼肌型重症肌无力患者循证制定最佳治疗方案。方法检索PubMed(1966～2010.4)、Cochrane图书馆(2010年第1期)、中国知识资源总库(1979～2010.4)及中文科技期刊数据库(1989～2010.4),获取并评价有关胆碱酯酶抑制剂、糖皮质激素、免疫球蛋白、免疫抑制剂、血浆置换和胸腺切除的临床指南、系统评价、随机对照试验、临床对照试验及病例观察研究。结果共纳入与眼肌型重症肌无力治疗有关的治疗指南2篇、系统评价5篇、观察性研究4篇,其分别评价了胆碱酯酶抑制剂、糖皮质激素、免疫球蛋白、免疫抑制剂及胸腺切除的疗效与安全性。眼肌型重症肌无力患者应首选溴吡斯的明治疗,若患者不能自发缓解,应在充分评估使用糖皮质激素的利弊后考虑使用激素治疗,激素疗效欠佳时可考虑加用免疫抑制剂长期服用以缓解症状。血浆置换术不作为眼肌型重症肌无力的推荐治疗,对合并胸腺瘤的患者应施行胸腺切除术。结论借助循证医学的方法可为眼肌型重症肌无力患者的治疗提供最佳临床证据。

Objective To collect evidence of treatment for the patients with ocular myasthenia gravis.Methods We searched The Cochrane Library（Issue 1,2010）,PubMed（1966 to April,2010）,CNKI（1979 to April,2010）and VIP（1989 to April 2010） to identify systematic reviews,randomized controlled trials,controlled clinical trials and prospective avaicohort studies about efficacy and safety of treatment for ocular myasthenia gravis.Results We identified 2 guidelines,5 systematic reviews and 4 observational studies on inhibitor of acetylcholinesterase,immunosuppressive agents,intravenous immunoglobulin,corticosteroids,and thymectomy for ocular myasthenia gravis.The first choice for ocular myasthenia gravis was inhibitor of acetylcholinesterase.When the symptom could not be remitted,the corticosteroids should be considered.Immunosuppressive agents might be added if the effect of corticosteroids was not good.Plasma exchange was not recommended.Thymectomy should be performed if the patients suffered from thymoma.Conclusion The best clinical evidence can be available by the evidence-based method.