胸腺切除术对眼肌型重症肌无力的疗效

Curative effects of thymectomy for ocular myasthenia gravis

目的:探讨眼肌型重症肌无力胸腺切除术的疗效及影响因素。方法:回顾性分析2012年10月至2019年10月在河南省人民医院重症肌无力综合诊疗中心及郑州大学第二附属医院胸外科接受胸腺切除治疗的眼肌型重症肌无力患者91例,收集患者的临床资料,并随访评价术后疗效。结果:91例中,非胸腺瘤51例、胸腺瘤40例;术前AChR-Ab阳性32例,阴性17例;术后1 a临床缓解35例,部分缓解40例,未缓解16例。有效(临床缓解+部分缓解)75例(82.42%),其中6例转化为全身型,转化率6.59%。女性、非胸腺瘤型、AChR-Ab阳性及发病年龄<50岁的患者术后疗效较好(P<0.05)。以疗效(有效=1,无效=0)为因变量,以病理类型、性别、发病年龄为调整因素,Logistic回归分析结果显示,术前病程(<12个月为对照)影响胸腺切除术的疗效,OR(95%CI)为0.184(0.041~0.837)。结论:胸腺切除治疗OMG疗效较优,术前病程是手术效果的重要影响因素。

Aim:To investigate the efficacy of thymectomy for ocular myasthenia gravis(OMG)and the influencing factors.Methods:A total of 91 OMG patients who underwent thymectomy at the Comprehensive Diagnosis and Treatment Center for Myasthenia Gravis of Henan Provincial People′s Hospital and the Second Affiliated Hospital of Zhengzhou University from October 2012 to October 2019,were enrolled.Clinical data were collected and postoperative efficacy were follow-up evaluated.Results:Among the 91 patients,51(56.04%)were non-thymoma and 40(43.96%)were thymoma.AChR-Ab was positive in 32(65.31%)and negative in 17(34.69%).One years after the operation,35 cases were clinical remission,40 cases were partial remission,and 16 cases did not obtain remission.Effective(clinical remission+partial remission)rate was 82.42%(75/91),out of the 75 cases,6 cases were converted to generalized type,and the conversion rate was 6.59%.The females,the patients with non-thymoma,AChR-Ab positive and onset age<50 years had better curative effects(P<0.05).Logistic regression with the efficacy(efficacy=1,inefficacy=0)as the dependent variable,and gender,the pathological type and age of onset as the adjusting factor,showed that the preoperative course(<12 months as control)were the influencing factor of efficacy,OR(95%CI)was 0.184(0.041-0.837).Conclusion:Thymectomy is an effective treatment for OMG,and preoperative course may be important factors influencing the results of thymectomy.