合并胸腺异常重症肌无力患者的临床特征分析

Analysis of the clinical characteristics of myasthenia gravis with thymic abnormities

目的分析合并胸腺异常重症肌无力(myasthenia gravis,MG)患者的临床特点。方法回顾性分析91例MG患者的临床资料,根据胸腺异常类型分为胸腺正常组55例(60.4%)、胸腺增生组16例(17.6%)和胸腺瘤组20例(22.0%)。比较3组患者的一般特征、首发症状、临床分型、病情严重程度、合并疾病及治疗方法等的差异。结果各组患者平均年龄、性别构成、发病类型、病情进展比较无统计学差异(均P>0.05)。胸腺增生组和胸腺瘤组首发症状表现为肢体无力者比例较胸腺正常组明显升高(χ~2=7.294,P<0.05)。入院时和病情最重时Osserman分型比例在3组间差异存在统计学意义(H=6.049,P<0.05;H=16.85,P<0.01)。3组患者在合并免疫性疾病方面存在统计学差异(χ~2=22.841,P<0.05),其中胸腺增生组比例最高为62.5%。除常规给予胆碱酯酶抑制剂治疗外,胸腺正常组合用激素治疗39例(70.9%),胸腺增生组5例(31.3%),胸腺瘤组8例(40.0%),3组间比较存在统计学差异(χ~2=11.036,P<0.01)。结论合并胸腺异常MG患者具有自身的临床特点,治疗方案有别于正常胸腺MG患者。

Objective To analyze the clinical feature of the myasthenia gravis（MG）associated with thymic abnormities.Methods The clinical data of MG patients admitted to our department were examined retrospectively.Patients with MG were divided into three groups based on the type of thymic abnormity：55（60.4%）patients had normal thymus,16（17.6%）patients had thymic hyperplasia and 20 patients（22.0%）had thymoma.The clinical features of MG patients of the three groups were compared,including the general features,presenting symptoms,clinical types,disease severity,accompanying diseases and treatments.Results 91 MG patients were enrolled in the present study.There were no significant difference in age,gender,clinical types or progression of the disease among these groups（P〈0.05）.The incidence of limb weakness was higher in the thymic hyperplasia and thymomas groups than that in the normal thymus group（χ^2=7.294,P〈0.05）.The independent samples Kruskal-Wallis H test showed that the Osserman stage was significantly different among three groups at disease onset and the most severe phase of the disease（H =6.049,P〈0.05;H =16.85,P〈0.01）.The proportions of coexisting autoimmune diseases were significantly different among these groups（χ^2=22.841,P〈0.05）and the thymic hyperplasia group had the highest ratio（62.5%）.In addition to cholinesterase inhibitor treatment,the percentages of patients who received glucocorticoid therapy were70.9%,31.3% and 40.0%in the normal thymus,thymic hyperplasia and thymomas groups respectively,and the difference was significant among these groups（χ^2=11.036,P〈0.01）.Conclusions MG patients with thymic abnormities show distinct clinical features.The treatment of these patients is different from the MG patients with normal thymus.