儿童眼肌型重症肌无力转换为全身型相关因素研究

Analysis of the risk factors for the conversion of ocular myasthenia gravis to generalized myasthenia gravis in children

目的探讨儿童眼肌型重症肌无力(ocular myasthenia gravis,OMG)的临床特征,并分析其转换为全身型重症肌无力(generalizedmyasthenia gravis,GMG)的相关因素。方法回顾性分析2017年9月至2019年9月于广州中医药大学第一附属医院门诊就诊且确诊为OMG患儿的临床信息,按照病情是否进展为GMG分为OMG组和GMG组,收集病历相关资料进行统计学分析。结果纳入的285例OMG患儿中,OMG组266例,GMG组19例,随访2年时间内转换为GMG的发生率为6.7%(19/285)。与OMG组比较,GMG组感染(χ^(2)=10.919,P=0.027)、合并甲状腺功能异常(χ^(2)=11.122,P=0.001)以及首发症状为眼睑闭合不全(χ^(2)=7.917,P=0.005)更多。多因素回归分析提示,诱发因素为感染(OR=3.859,95%CI:1.306~11.406,P=0.015)、合并甲状腺功能异常(OR=5.335,95%CI:1.438~19.792,P=0.012)、首发症状为眼睑闭合不全(OR=4.820,95%CI:1.457~15.940,P=0.010)将增加OMG转换为GMG的风险,均有统计学意义(P<0.05)。结论感染、合并甲状腺功能异常以及首发症状为眼睑闭合不全为儿童OMG向GMG转换的危险因素。

Objective To investigate the clinical characteristics of ocular muscular myasthenia(OMG)in children,and analyze the risk factors related to its conversion to generalized myasthenia gravis(GMG).Methods A retrospective analysis was conducted on clinical data of children with OMG who visited the outpatient clinic at the First Affiliated Hospital of Guangzhou University of Chinese Traditional Medicine from September 2017 to September 2019.Children were divided into conversion group and non-conversion group according to whether their disease progressed to GMG.Data related to medical records were collected for statistical analysis.Results Among the 285 children with OMG,266 cases were in OMG group and 19 cases in GMG group.The incidence of conversion to GMG was 6.7%(19/285)during a two year follow-up period.Univariate regression analysis showed that patients with the first symptoms of incomplete closure(χ^(2)=7.917,P=0.005),infection-induced(χ^(2)=10.919,P=0.027)and thyroid dysfunction(χ^(2)=11.122,P=0.001)were more likely to be converted to GMG.Multivariate regression analysis also suggested that the first symptoms of incomplete closure(OR=4.820,95%CI:1.457~15.940,P=0.010),infection-induced(OR=3.859,95%CI:1.306~11.406,P=0.015)and thyroid dysfunction(OR=5.335,95%CI:1.438~19.792,P=0.012)significantly increased the risk of OMG switching to GMG(P<0.05).Conclusion Infection,first symptom of incomplete closure and combined thyroid dysfunction are the risk factors for the conversion of OMG to GMG in children.