口咽肌群受累的重症肌无力患者住院期间发生肌无力危象的相关因素分析

Factors related to myasthenic crisis in myasthenia gravis patients with oropharyngeal involvement during hospitalization

目的探讨口咽肌群受累的重症肌无力(MG)患者住院期间发生肌无力危象(MC)的相关因素。方法回顾性收集2018-2020年首都医科大学附属北京同仁医院收治的99例口咽肌群受累MG患者的临床资料,其中男52例,女47例。入院时年龄17~89(55±15)岁,病程为1~240[10(4,36)]个月。根据患者住院期间是否发展为MC,应用多因素logistic回归方法,分析其进展至MC的相关因素。结果 99例患者符合纳入条件,其中19例(19.19%)在住院期间发展为MC。多因素logistic回归分析显示年龄≥60岁(OR=31.378, 95%CI:3.868~254.557,P=0.001)、B型及C型胸腺瘤(OR=29.175, 95%CI:2.986~285.016,P=0.004)、口腔分泌物增多(OR=12.649,95%CI:2.057~77.783,P=0.006)及感染(OR=9.539, 95%CI: 1.345~67.645,P=0.024)为口咽肌群受累MG发展为MC的独立相关因素。结论高龄、伴有恶性胸腺瘤、口腔分泌物增多及伴有感染为口咽肌群受累MG 患者住院期间发展至MC的独立相关因素,对该类型MG应高度重视,积极处理口腔分泌物,防治感染,以减少MC的发生。

Objective To investigate the factors related to myasthenic crisis(MC)in myasthenia gravis patients(MG)with oropharyngeal involvement during hospitalization.Methods The clinical data of 99 MG patients with oropharyngeal involvement who were admitted to Beijing Tongren Hospital from 2018 to 2020 were retrospectively reviewed.There were 52 males and 47 females,aged 17-89(55±15)years old,with a disease duration of 1-240[10(4,36)]months.Multivariable logistic regression analysis was used to determine the factors associated with MC.Results A total of 19(19.19%)patients developed into MC during hospitalization.Multivariate logistic regression analysis showed that age of hospitalization≥60 years old(OR=31.378,95%CI:3.868-254.557,P=0.001),type B and C thymoma(OR=29.175,95%CI:2.986-285.016,P=0.004),excess oropharyngeal secretions(OR=12.649,95%CI:2.057-77.783,P=0.006)and infections(OR=9.539,95%CI:1.345-67.645,P=0.024)were independently related to MC in MG patients with oropharyngeal involvement.Conclusions Older age,malignant thymoma,excess oropharyngeal secretions and infection are independently related to MC in MG patients with oropharyngeal involvement during hospitalization.Therefore,great attention should be paid to this type of MG patients,and increased oropharyngeal secretions and various infections should be actively treated,so as to reduce the occurrence of MC.