胸腺切除术后发生肌无力危象危险因素的Meta分析

Risk factors of myasthenic crisis after thymectomy ： a meta analysis

目的探讨胸腺切除术后肌无力危象发生的危险因素。方法计算机检索PUBMED、THECOCHRANELIBRARY、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、万方医学数据库，截止日期至2014年10月。收集公开发表的关于胸腺切除术后肌无力危象危险因素的研究文献，采用Stata12．0软件进行统计分析。结果共纳入21篇文献，累计病例3092例，发生肌无力危象698例（22．5％），其中合并胸腺瘤患者（OR=3．93，95％CI：2．37～6．50，P=0．000）、Osserman分型（OR=0．12，95％CI：0．09-0．17，P=0．000）、术前有危象病史（OR=5．36，95％CI：3．82～7．51，P=0．000）、术前激素治疗（OR=1．75，95％CI：1．26-2．43，P=0．001）、术后肺部感染（OR=4．27，95％CI：1．63-11．18，P=0．003）、手术方式（OR=0．34，95％CI：0．21～0．56，P=0．000）、术前抗胆碱酯酶药量（OR=0．35，95％CI：0．18-0．66，P=0．000）、术前肺功能（OR=0．18，95％CI：0．06～0．57，P=0．004）、乙酰胆碱抗体（AchR—Ab）滴度（OR=0．06，95％CI：0．03-0．13，P=0．000）与术后肌无力危象发生有关；而性别、术前病程与术后肌无力危象发生无明显相关（均P〉0．05）。结论合并胸腺瘤、肌无力危象史、Osserman分型，肺功能、术后肺部感染、药物或激素的使用、手术方式及抗体滴度都可能与术后肌无力危象的发生相关。

Objective To evaluate the risk factors of myasthenic crisis ＇after thymectomy for myasthenia gravis. Methods Meta-analysis was performed to screen risk factors of myasthenic crisis after thymectomy for myasthenia gravis based on 21 as- sociated articles published and carried out using Statal 2.0. Results Twenty one studies were identified, including 3 092 pa- tients and 698 patients developed myasthenic crisis after thymeetomy. Complicated with thymoma（ OR = 3.93,95% CI 2.37 - 6.50, P = 0. 000 ） , Ossermen classification （ OR =0. 12, 95 % CI 0. 09 - 0.17 , P = 0. 000 ） , history of preoperative myas- thenie crisis （ OR = 5.36, 95 % CI3.82 - 7.51, P = 0. 000 ） , use steroid hormonea （ OR = 1.75, 95 % CI 1.26 - 2.43, P = 0. 001 ）, postopertive lung infection （ OR = 4.27,95 % CI 1.63 - 11.18, P = 0. 003 ）, operation methods （ OR = 0.34,95 % CI 0. 21 - 0.56, P = 0. 000 ） , the dose of preoperative anticholinesterase drugs （ OR = 0.35, 95% CI 0. 18 - 0.66, P = 0. 000） , pulmonary function（ OR =0.18, 95% CI0. 06 -0.57, P =0. 004） , preoperative serum level of anti-aeetylcholine receptor an- tibody （ OR = 0.06, 95 % CI 0. 03 - 0.13, P = 0. 000 ） were associated with myasthenic crisis after thymectomy. Gender, course of disease were not associated with myasthenic crisis after thymectomy. Conclusion With thymoma, Ossermen classification, history of preoperative myasthenic crisis, use steroid hormonea, operation methods, the high dose of preoperative anticholinest- erase drugs, poor pulmonary function, postopertive lung infection, high preoperative serum level of anti-acetylcholine receptor antibody are risk factors affecting myasthenic crisis after thymectomy.