重症肌无力伴胸腺瘤或胸腺增生患者神经电生理特点及手术的影响

Electrophysiological characteristics in myasthenia gravis with thymoma or thymic hyperplasia and the impacts of thymectomy

目的探讨重症肌无力伴胸腺瘤及胸腺增生患者的电生理指标特点,并观察胸腺切除手术对于电生理指标的影响。方法对12例伴有胸腺瘤、25例伴有胸腺增生的重症肌无力患者进行伸指总肌单纤维肌电图(SFEMG)、重复神经电刺激(RNS)和肌电图(EMG)检测,比较两组间的神经电生理特点,同时观察手术前、后电生理指标的变化。结果 12例伴有胸腺瘤患者术前的SFEMG、RNS、肌电图的异常率分别为100%、41.4%和25%,25例伴有胸腺增生患者术前的SFEMG、RNS、肌电图异常率分别为92%、52%和32%;12例伴有胸腺瘤患者手术后的SFEMG、RNS、肌电图异常率为91.7%、33.3%和25%,25例胸腺增生手术后为86.9%、40%和24%。结论伴有胸腺瘤及胸腺增生患者的SFEMG阳性率最高,其次为RNS、肌电图,手术后电生理指标有改善,而其中胸腺增生者改善更为明显,但均仍存在异常,仍需药物治疗。

Objective To analyze the electrophysiological characteristics in patients with myasthenia gravis（MG） and thymoma and to investigate the electrophysiological impacts of thymectomy.Methods 12 patients with MG and thymoma and 25 patients with MG and thymic hyperplasia were enrolled into our study.All patients were examined with SFEMG,low frequency repeated nerve stimulation（RNS）,and electromyograph（EMG） before and after surgery.Electrophysiological parameters were compared between thymoma and thymic hyperplasia,and were compared before and after surgery.Results The abnormal rate of the SEFMG and RNS among the patients with thymoma reached 100% and 41.4% before the surgery,and decreased to 91.7% and 33.3% after the surgery,respectively,while that of EMG stayed at 25% before and after surgery.The abnormal rate of SFEMG,RNS and EMG in the patients with thymic hyperplasia was 92%,52% and 32%,respectively,before the surgery,and decreased to 86.9%,40%,24% after the surgery.Conclusion SFEMG is the most sensitive examination for MG.Electrophysiological findings in MG patients with thymoma were worse than those with thymic hyperplasia.