眼外肌起病的重症肌无力新斯的明试验方法的评价

Evaluation of neostigmine test in diagnosis of myasthenia gravis initiated from extrocular muscles

目的 观察新斯的明试验在眼外肌起病的重症肌无力（myasthenia gravis,MG）诊断中的应用现状,包括试验方法和结论分析.方法 对2012年1-12月于我院就诊的以眼外肌起病的100例MG患者进行回顾性研究,对患者进行登记注册和随诊,包括首发症状、症状演变、就诊次数和专科、新斯的明肌肉注射试验应用的方法学和结果判断等.结果 （1）本组MG患者均以单眼睑下垂或双眼睑下垂、复视起病,其中46％ （46/100）有眼睑下垂伴有复视.其中21％ （21/100）在新斯的明试验前已出现眼外肌以外的症状.78％ （78/100）的患者会首选眼科就诊,首次就诊的时间为（0.7±0.3）个月.首次神经科就诊的时间为（1.6±1.3）个月,从发病至诊断的时间（3.3±2.1）个月.（2）首次新斯的明试验为神经科就诊（2.0±1.5）次时进行,距发病时间（2.0±1.8）个月.低剂量的肌肉注射新斯的明试验阳性率较规范的新斯的明肌肉注射试验阳性率低[60.9％（14/23）与98.3％（58/59）,x2=18.30,P＜0.01],口服溴吡斯的明试验性治疗阳性率低于肌肉注射新斯的明试验[15/18与98.3％（58/59）,x2=4.428,P=0.035].（3）新斯的明试验不良反应达65％（65/100）,但均为轻度至中度.结论 对眼外肌麻痹的MG患者新斯的明试验的不规范应用会降低新斯的明试验的阳性发现,应重视规范化的新斯的明肌肉注射试验.

Objective To investigate the usage of neostigmine test in diagnosis of myasthenia gravis （MG） initiated from extraocular muscles,including test methods and data analysis.Methods The clinical features of 100 consecutive patients with myasthenia gravis initiated from extraocular muscles were collected retrospectivelly,including initial symptom,number and department of visiting,evolution of symptoms and signs,methods and the judgment of therapeutic response for neostigmine test.Results （1） All patients with MG started from ptosis unilateral or bilateral or diplopia,among which 46% （46/100）of patients with both ptosis and diplopia.Within 21% （21/100） of patients,other muscles had been involved except for extrocular muscles before neostigmine test.Seventy-eight percent patients first consulted ophthalmology after （0.7 ± 0.3） month from onset.It took （1.6 ± 1.3） months for patients to visit neurologist for the first time.The average time for confirming diagnosis was （3.3 ± 2.1） months.（2） After （2.0 ± 1.5） times consulted at neurology department and （2.0 ± 1.8） months after symptoms onset,the patients undergone neostigmine test.Positive reaction rate showed lower in low dosage group （60.9% （14/23） vs 98.3% （58/59）,x2 =18.30,P 〈0.01）.Positive rate also showed lower in oral-take pyridostigmine bromide tablets group than neostigmine methylsulfate injection group（15/18 vs 98.3% （58/59）,x2 =4.428,P =0.035）.（3） Sixtyfive percent patients had mild to moderate side effects after neostigmine injection,which disappeared in 60-120 minutes.Conclusions Non-standard operations of neostigmine test reduced the effectiveness of its diagnosis for MG initiated from extraocular muscles.Neurologist should attach importance totake standard neostigmine test to identify MG as soon as possible.