515例重症肌无力的临床回顾性研究

Clinical Characteristics of 515 Patients with Myasthenia Gravis: A Retrospective Study

目的探讨重症肌无力(MG)的发病规律、临床特征及治疗效果。方法回顾性分析515例MG患者的临床资料。结果①MG患者:男女性别比为1.0∶1.18;发病年龄(43.1±13.7)岁。②诱因:无诱因51.07%,感染23.11%,劳累压力13.20%,手术史(包括胸腺切除术及其他手术)5.63%,擅自停药4.66%,外伤1.75%。③首发症状:眼部症状64.47%,吞咽困难9.13%,咀嚼无力8.73%,肢体无力14.76%。④改良Ossermann分型:Ⅰ型20.78%,Ⅱa型34.17%,Ⅱb型29.90%,Ⅲ型9.13%,Ⅳ型3.69%,Ⅴ型2.33%。⑤MG危象发生率10.16%。⑥新斯的明试验阳性率93.54%;重复神经电刺激(RNES)阳性率58.46%;疲劳试验阳性率93.79%;乙酰胆碱受体-抗体阳性率32.04%;胸腺影像学异常阳性率28.71%。⑦胆碱酯酶抑制剂、肾上腺皮质激素、丙种球蛋白、胸腺切除术治疗,4组疗效比较差异无统计学意义。结论MG发病以青壮年为主,女性多于男性,多无明显诱因;临床分型以Ⅱ型多见;新斯的明试验、疲劳试验、RNES、乙酰胆碱受体-抗体、胸腺影像学检查可协助诊断;胆碱酯酶抑制剂、肾上腺皮质激素、丙种球蛋白、胸腺切除术治疗效果无差异。

Aim To study the onset rule, clinical characteristics and treatment effect of myasthenia gravis(MG). Methods Clinical data of 515 MG patients admitted to our hospital in the last 10 years were retrospectively analyzed. Results ①Male-to-female ratio was 1:1.18 in 515 MG patients, whose age of onset were(43.1 ± 13.7) years old. ② The percentage of cases without inductive factors was 51.07%, infections was 23.11%, tired and pressure was 13.20%, surgeries was 5.63%, drug discontinuance without the guidance was 4.66%, trauma was 1.75%. ③ The percentage of cases with the initial symptom of eyes was 64.47%, dysphagia was 9.13%, dysmasesis was 8.73%, acroparalysis was 14.76%. ④ According to the modified Ossermann classification, type Ⅰ was 20.78%, type Ⅱ a was 34.17%, type Ⅱ b was 29.90%, type Ⅲ was 9.13%, type Ⅳ was 3.69% and type Ⅴ was 2.33%. ⑤ Incidence rate of myasthenic crisis was 10.16%. ⑥Positive rate of neostigmine test was 93.54%. Positive rate of repeating nerve electric stimulation(RNES) was 58.46%. Positive rate of Jolly test was 93.79%. Positive rate of AChR-Ab was 32.04%. Anomalous image of thymus was 28.71%. ⑦No significant difference of efficacy was found among the four treatment groups. Conclusion MG occured mainly in young or middle-aged individuals and more in females than in males. Most MG occured without dominant inductive factors, and was often Type Ⅱ in Ossermann classifications. Neostigmine test, RNES, Jolly test, AChR-Ab and chest image examination were contribute to MG diagnosis. No significant difference of efficacy was found among cholinesterase inhibitor, corticosteroids, intravenous immunoglobulin and thymectomy.