胸腺瘤合并重症肌无力与单纯重症肌无力的临床特征及手术疗效分析

Clinical characteristics and outcome of myasthenia gravis with and without thymoma after operation

目的 探讨胸腺瘤合并重症肌无力 (MG)与单纯MG的临床特征及手术疗效。方法回顾性分析 1978年至 2 0 0 3年 2 4 3例MG患者临床资料 ,比较胸腺瘤合并MG组 (6 8例 )与单纯MG组 (175例 )的临床特点 ,以及术后并发症、缓解率、生存情况。结果 胸腺瘤合并MG组较单纯MG组年龄大 [平均年龄分别为 (41± 14 )与 (2 8± 16 )岁 ,t=6 .138,P =0 0 0 0 ]、病程短 (平均分别为 10、2 4个月 ,t =3 783,P =0 0 0 0 ) ,术后肌无力危象发生率高 [分别为 5 0 0 % (34/ 6 8)与 5 7% (10 / 175 ) ,χ2=6 4 77,P =0 0 0 0〗 ,两组Osserman分型差异无显著意义 (χ2 =7 6 78,P =0 10 4 )。胸腺瘤合并MG组肌无力症状完全缓解率、部分缓解率 ,术后 1年分别为 10 2 % (6例 )、6 2 7% (37例 ) ,术后 3年分别为 2 1 6 % (8例 )、75 7% (2 8例 ) ,低于单纯MG组 [术后 1年分别为 2 2 1% (30例 )、94 1% (12 8例 ) ,术后 3年分别为 4 4 4 % (44例 )、94 9% (94例 ) ,P值分别为 0 0 4 9、0 0 0 0、0 0 15、0 0 10 ];术后 5年两组比较肌无力症状完全缓解率、部分缓解率差异无显著意义 (P =0 4 5 7,P =0 6 99)。胸腺瘤合并MG组 3、5年生存率分别为 96 3%、84 4 % ,显著低于单纯MG组的

ObjectiveTo explore the clinical characteristics and outcome of myasthenia gravis with and without thymoma after operation. MethodsTwo hundred and forty-three patients with myasthenia gravis surgically treated in our department from 1978 to 2003 were studied retrospectively. The clinical characteristics,complication,remission and survival were compared between myasthenia gravis with and without thymoma. ResultsThe patients of myasthenia gravis with thymoma were significantly older( t =6.138, P =0.000),had shorter duration of symptome( t =3.783, P =0.000),and also had higher myasthenia crisis rates after operation(χ 2=64.77, P =0.000) than those of myasthenia gravis without thymoma. No differences of Osserman classification was found between the two groups(χ 2=7.678, P =0.104). The complete remission rates and partial remission rates of myasthenia gravis with thymoma were significantly lower than those of myasthenia gravis without thymoma at 1 and 3 years( P =0.049? P =0.000; P =0.015? P =0.010),but no differences at 5 year( P =0.457; P =0.699). The survival rates of MG with thymoma were lower than that of MG without thymoma(Log-rank=18.58, P =0.000). ConclusionsThe clinical characteristics are different between myasthenia gravis with and without thymoma. The remission of symptom of myasthenia gravis with thymoma is worse than that of myasthenia gravis without thymoma in the near future,but is similar in the long future. The death rates of MG with thymoma is significantly higher than that of MG without thymoma.