CAJ | 학술논문

目的探讨应用血浆置换治疗重症肌无力危象的影响因素,寻找应用血浆置换治疗效果不好的原因.方法对中山大学附属第一医院神经内科1995年6月至2010年4月69例应用血浆置换的重症肌无力危象患者的影响因素采用病例-对照研究.回顾性分析的项目包括:性别、发病年龄、危象发生距离血浆置换的时间、治疗前激素史、肺部感染史、其他并发症、营养状况、危象前48 h内胸腺手术史,胸腺病理类型、治疗后合用内种球蛋白、总置换次数.结果通过单因素Logistic回归分析得出肺部感染(P=0.000,OR=29.250),危象前48 h内胸腺手术史(P=0.046,OR=0.267),治疗后合用内种球蛋白(P=0.003,OR=0.136),总置换次数(P=0.022,OR=0.498)是影响血浆置换效果的相关因素.以上因素引入Logistic回归模型,进行多因素Logistic回归分析,发现肺部感染(P=0.000,OR=23.600)为独立危险因素,而治疗后合用丙种球蛋白(P=0.047,OR=0.192)为保护因素.结论重症肌无力危象合并肺部感染时,血浆置换治疗效果不佳.积极控制肺部感染,治疗后与丙种球蛋白合用可提高血浆置换治疗重症肌无力危象的效果.
목적 탐토응용혈장치환치료중증기무력위상적영향인소,심조응용혈장치환치료효과불호적원인.방법 대중산대학부속제일의원신경내과1995년6월지2010년4월69례응용혈장치환적중증기무력위상환자적영향인소채용병례-대조연구.회고성분석적항목포괄:성별、발병년령、위상발생거리혈장치환적시간、치료전격소사、폐부감염사、기타병발증、영양상황、위상전48 h내흉선수술사,흉선병리류형、치료후합용내충구단백、총치환차수.결과 통과단인소Logistic회귀분석득출폐부감염(P=0.000,OR=29.250),위상전48 h내흉선수술사(P=0.046,OR=0.267),치료후합용내충구단백(P=0.003,OR=0.136),총치환차수(P=0.022,OR=0.498)시영향혈장치환효과적상관인소.이상인소인입Logistic회귀모형,진행다인소Logistic회귀분석,발현폐부감염(P=0.000,OR=23.600)위독립위험인소,이치료후합용병충구단백(P=0.047,OR=0.192)위보호인소.결론 중증기무력위상합병폐부감염시,혈장치환치료효과불가.적겁공제폐부감염,치료후여병충구단백합용가제고혈장치환치료중증기무력위상적효과.
Objective To examine the prognostic factors and efficacy of myasthenia gravis (MG) in crisis on plasmapheresis and detect the reasons for ineffective plasmapheresis. Methods The investigators analyzed a total of 69 MG patients in crisis on plasmapheresis by case control study. Gender, age at onset of myasthenic symptoms, duration between the onset of crisis and plasmapheresis, pre-therapeutic use of glucocorticoids, pulmonary infections, other complications, nutritional status, history of thymectomy in 48 hours before crisis, thymic pathology, combined intravenous immunoglobulin (IVIG) and total sessions of plasmapheresis were measured retrospectively. Results Univariate analysis showed that pulmonary infections (P = 0. 000, OR = 29. 250), history of thymectomy in 48 hours before crisis (P = 0. 046, OR = 0. 267),combined intravenous immunoglobulin (P = 0. 003, OR = 0. 136) and total sessions of plasmapheresis (P =0. 022, OR = 0. 498) were all influencing factors of plasmapheresis. However the analysis of multivariate logistic regression revealed that pulmonary infections (P = 0. 000, OR = 23. 600) was an independent risk factor and combined intravenous immunoglobulin (P = 0. 047, OR = 0. 192) was an independent protection factor of plasmapheresis. Conclusion Plasmapheresis is ineffective in MG crisis with pulmonary infections.Control of pulmonary infections and combined intravenous immunoglobulin can improve the response to plasmapheresis in patients with MG crisis.