胸腺瘤手术后新发重症肌无力的研究进展

Recent Advances in Post-operatively New Onset Myasthenia Gravis in Thymoma Patients

术前没有合并重症肌无力的胸腺瘤患者在肿瘤切除术后可能出现重症肌无力症状,对这种少见的临床现象尚缺乏全面的认识。研究认为,术后新发重症肌无力是多种形成机制及其相互作用的结果,可能与胸腺瘤介导异常T细胞与自身免疫抗体的生成、释放并在外周长期存在有关,也可能与异位胸腺的存在、胸腺瘤的晚期复发有关。术前抗体滴度是其主要的预测因子。治疗策略以抗胆碱酯酶药和激素治疗为主。本文结合近年文献,对术后新发重症肌无力的发生率、发病机制、预测因子及防治策略等作一综述。

Patients with thymoma without preoperative myasthenia gravis may develop symptoms of myasthenia gravis after tumor resection.A comprehensive understanding toward this rare clinical phenomenon is lacking.Recent studies indicate that post-operatively new onset myasthenia gravis(ponoMG)is the result of multiple mechanisms and their interactions,which may be related to the thymoma-mediated production,release and long-term presence of abnormal T cells and autoimmune antibodies in the periphery,as well as the presence of ectopic thymus and late recurrence of thymoma.Preoperative antibody titer is the main predictor.The treatment strategy is based on anticholinesterase drugs and hormonal therapy.In this study,we review the incidence,pathogenesis,predictors,and prevention and treatment strategies of ponoMG.