外科治疗重症肌无力术后症状加重相关因素研究

Study on related factors of postoperative symptom aggravation in surgical treatment of myasthenia gravis

目的探讨外科治疗重症肌无力(MG)术后症状加重的相关因素。方法回顾性分析2013年6月~2019年6月于郑州大学第二附属医院行胸腺切除术治疗的128例MG患者的临床资料,按照MG外科分型标准评估每例患者术前分型和术后分型,以是否加重为标准将其分为加重组和平稳组。加重组:经过手术治疗后患者在住院期间症状加重(型别增加),或所需服用药量增加;平稳组:经过手术治疗后患者在住院期间症状缓解(型别降低)或不变(型别不变),或维持当前症状所需服用药物量减少。采用单因素及多因素Logistic回归分析患者术后症状加重的相关因素。结果128例患者中,加重组40例,平稳组88例。两组患者的手术方式、Osserman分型和胸腺病理类型比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,手术方式、Osserman分型和胸腺病理类型是影响MG患者术后症状加重的相关因素(P<0.05),Osserman分型中,ⅡB型、Ⅲ型相对于Ⅰ型的MG患者,术后症状加重概率较高。结论胸腺切除术是MG的主要外科治疗手段,手术方式的选择、Osserman分型和胸腺瘤的病理类型是MG患者外科治疗后症状加重的相关因素。选择合理的手术方式,并结合MG Osserman分型和胸腺的病理类型,对于预防MG术后症状加重有指导意义。

Objective To explore the related factors of postoperative symptom aggravation in surgical treatment of myasthenia gravis(MG).Methods The clinical data of 128 patients with MG who underwent thymectomy in the Second Affiliated Hospital of Zhengzhou University from June 2013 to June 2019 were retrospectively analyzed.The preoperative and postoperative classifications of each patient were evaluated according to the surgical classification standard of MG,and patients were divided into the addition group and the stable group based on whether they were aggravated.The addition group:after surgery,the symptoms of MG patients were aggravated during the hospitalization(type increased),or the amount of medication requirement was increased.The stable group:after surgery,the symptoms of MG patients were relieved(type reduced)or unchanged(type unchanged)during the hospitalization,or the amount of medication needed to maintain current symptoms was reduced.Single factor and multivariate Logistic regression were used to analyze the related factors of postoperative symptoms aggravated.Results Of the 128 patients,40 cases were in the addition group,and 88 cases were in the stable group.There were statistically significant differences in the surgical methods,Osserman classification and pathological types of thymus between the two groups(P<0.05).Logistic regression analysis showed that surgical methods,Osserman classification,and thymus pathological type were related factors affecting postoperative symptoms of MG patients(P<0.05).In Osserman classification,compared with typeⅠMG patients,patients of typesⅡB andⅢhad a higher probability of postoperative aggravation of symptoms.Conclusion Thymectomy is the main surgical treatment for MG.The choice of surgical methods,Osserman classification and the pathological type of thymoma are related factors for the aggravation of symptoms in MG patients after surgical treatment.Choosing a reasonable surgical method,combined with the MG Osserman classification and the pathological type of the thymus,has guiding significance for the prevention of postoperative symptoms of MG.