262例重症肌无力临床特征及相关因素回顾性分析

Clinical Features and Related Factors of 262 Cases of Myasthenia Gravis

目的:对262例重症肌无力(myasthenia gravis, MG)病例临床特征及相关因素进行回顾分析,为临床治疗提供参考。方法:收集2013年8月—2016年12月广州中医药大学第一附属医院确诊的262例MG患者病例资料,探讨患者发病诱因及复发加重因素、中医证型、西医分型与胸腺瘤的相关性及胸腺瘤与MG危象发生的关系。结果:MG以女性多见,男∶女=1∶1.45;可因感染、劳累、减药等诱因导致复发或病情加重,其中肺部感染最为常见。Osserman分型最多为Ⅱb型患者,共150例(57.25%);中医证型中脾胃气虚证所占比例最高,共141例(53.82%);Ⅲ型及IV型患者合并胸腺瘤比例明显高于另外两型患者;合并胸腺瘤患者危象发生率明显高于无胸腺瘤患者。结论:MG是因虚致损的疾病,脾胃虚损为其主要病机;临床以脾胃气虚证、脾虚湿热证及脾肾亏虚证为常见证型,胸腺瘤为其病程中逐渐形成的病理产物,胸腺瘤与MG的严重程度及危象的发生存在明显相关性,临症需标本兼顾。

Objective:Through retrospective analysis of 262 patients with myasthenia gravis(MG)to provide guidance for optimization of clinical treatment of MG.Methods:Totally 262 cases of MG diagnosed in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from August 2013 to December 2016 were collected,inducingrecurrence and aggravation factors,the correlation between TCM syndrome,the classification of Western medicine,MG crisis and thymoma were discussed.Results:MG was more common in women,male∶female=1∶1.45.Recurrence or aggravation can be caused by infection,fatigueand drug reduction,among which lung infection was the most common.The typeⅡb was the most common in clinical classification of Osserman type,which were 150 cases(57.25%).MG with spleen Qi deficiency syndrome in hospitalized patients had the highest proportion,which were 141 cases(53.82%).The proportion of typeⅢand IV patients with thymoma were significantly higher than that of the other two types.Patients with thymoma had significantly higher incidence with MG crisis thanthose without thymoma.Conclusion:MG is a disease caused by deficiency whose main mechanism is spleen deficiency.Thymoma is pathological product gradually formed in the course,which is related to theseverity and the occurrence of MG crisis.The treatment needs to be taken into account both from manifestation and root cause of disease.