老年起病型重症肌无力患者的临床特点

Clinical features of elderly-onset myasthenia gravis patients

目的探讨老年起病型重症肌无力(MG)的临床特点。方法回顾性分析332例起病年龄≥65岁的MG患者的临床资料。结果该组MG患者男女比例为1.3∶1。全身型MG(GMG)和眼肌型MG(OMG)的比例为1.9∶1,OMG在男性多于女性而GMG在女性多于男性(P=0.033)。以OMG起病和以GMG起病的比例为1.5∶1,起病症状以眼睑下垂最多见占38.6%;在以OMG起病的患者中,女性患者转化为GMG的比率要明显高于男性患者(P=0.035)。病程中位数为3.7年,平均定量MG评分为7分。新斯的明试验阳性率为96.7%。低频重复频率电刺激波幅递减的总体发生率为48.2%,其中面神经的阳性率最高。MG合并胸腺异常的发生率为36.3%,以合并胸腺瘤者最多;胸腺瘤手术后病理分型以AB型最多,女性患者AB型胸腺瘤所占的比率要明显高于男性(P=0.048)。MG合并甲状腺功能异常的发生率为16%,以合并甲状腺功能亢进者最多。结论老年起病型MG患者GMG多于OMG、以OMG起病的女性患者转化为GMG的比率高于男性患者,胸腺瘤是最常见的胸腺异常且最常见的胸腺瘤病理分型为AB型。充分认识其临床特点有利于更好的治疗该类患者。

Objective To investigate the clinical features of elderly-onset myasthenia gravis( MG) patients. Methods The clinical data of 322 MG patients whose onset age was just or older than 65 years and were admitted to Tangdu Hospital of Fourth Military Medical University from March 2010 to March 2015 were retrospectively analyzed. Results Among those MG patients,the male to female ratio was 1.3 ∶ 1.The ratio of generalized MG( GMG) to ocular MG( OMG) was 1.9 ∶ 1,male was more common in OMG while female was more common in GMG ( P = 0. 035).The ratio of patients onset symptom as OMG to patients onset symptom as GMG was 1. 5 ∶ 1,the most common onset symptom was eyelid ptosis and accounted for 38.6%.Among patients whose onset symptom was OMG, the proportion of OMG progressed to GMG in female was significantly higher than male ( P = 0. 035).The media disease duration were 3. 7 years,the average QMG score was 7.The positive rate of Neostigmine test was 96. 7%. The repetitive nerve stimulation decrement of amplitude was positive in 48. 2% of the patients,the facial nerve had the highest positive rate.Patients who combined with thymus disfunction accounted for 36. 3% and the most frequent one was thymoma.The most common pathological type of thymoma after thymectomy was AB,the proportion of pathological type AB of female was significantly higher than male ( P = 0. 048).Patients who combined with thyroid disfunction accounted for 16% and the most frequent one was hyperthyroidism.Conclusions The clinical features of elderly-onset MG patients included GMG is more frequent than OMG,the transformation rate of OMG to GMG is higher in female than male.The most frequent thymus disfunction is thymoma and the most common pathological type of thymoma after thymectomy is AB.Fully understanding its clinical characteristics is beneficial for better treatment of this kind of MG patients.