CAJ | 학술논문

目的探讨重症肌无力(MG)患者胸腺扩大切除术后复发的影响因素.方法对1990年1月到2006年1月在中山大学附属第一医院行胸腺扩大切除术后缓解的271例MG患者进行随访,对复发的影响因素采用病例-对照研究的方法.影响因素包括:性别、手术时年龄、手术时病程、胸腺病理类型、术前是否用(肾上腺皮质)激素、手术时临床分型(Osserman分型)、术后是否立即用激素、术后感冒/感染、术后仅服吡啶斯的明、术后无症状1～3个月即停药或减药.结果 135例术后复发.COX单因素分析显示:术后未立即用激素(OR=2.914,P=0.000),术后感冒/感染(OR=3.441,P=0.000),术后仅服吡啶斯的明(OR=5.947,P=0.000),术后无症状1～3个月即停药或减药(OR=2.242,P=0.000)为术后复发的危险因素.COX多因素分析显示:术后感冒/感染(OR=47.63,P=0.000)、术后仅服吡啶斯的明(OR=62.38,P=0.000)、术后无症状1～3个月即停药或减药(OR=32.76,P=0.000)是术后复发的独立影响因素.结论术后感冒/感染、术后仅服吡啶斯的明、术后无症状1～3个月即停药或减药是术后复发的独立影响因素.术后正规治疗,及时使用激素可以降低术后症状的复发.
목적 탐토중증기무력(MG)환자흉선확대절제술후복발적영향인소.방법 대1990년1월도2006년1월재중산대학부속제일의원행흉선확대절제술후완해적271례MG환자진행수방,대복발적영향인소채용병례-대조연구적방법.영향인소포괄:성별、수술시년령、수술시병정、흉선병리류형、술전시부용(신상선피질)격소、수술시림상분형(Osserman분형)、술후시부립즉용격소、술후감모/감염、술후부복필정사적명、술후무증상1～3개월즉정약혹감약.결과 135례술후복발.COX단인소분석현시:술후미립즉용격소(OR=2.914,P=0.000),술후감모/감염(OR=3.441,P=0.000),술후부복필정사적명(OR=5.947,P=0.000),술후무증상1～3개월즉정약혹감약(OR=2.242,P=0.000)위술후복발적위험인소.COX다인소분석현시:술후감모/감염(OR=47.63,P=0.000)、술후부복필정사적명(OR=62.38,P=0.000)、술후무증상1～3개월즉정약혹감약(OR=32.76,P=0.000)시술후복발적독립영향인소.결론 술후감모/감염、술후부복필정사적명、술후무증상1～3개월즉정약혹감약시술후복발적독립영향인소.술후정규치료,급시사용격소가이강저술후증상적복발.
Objective To identify the recurrence-related factors in patients with myasthenia gravis (MG)after extended thymectomy.Methods Followed up was conducted on 271 MG patients,127 males and 146 females,aged 31(4-57),who underwent extended thymectomy for 18-84 months.Post.operational pathological examination showed 32 cases of thymoma and 239 cases of diseases other than tnymoma. Atter operation the patients were treated with pyridostigmine only or combined with adrenocortical hormone.The relevant factors of the 135 patients with relapse were evaluated:sex,Ossemlan classification,age while being operated on,duration of preoperative period,pathologic type of thymus.use of steroid before operation,infection after operation, whether only taking anticholinesterase drugs after operation. use of steroid immediately after operation,stopping medicine or decreasing the dose of medicine within 1-3 months after remission of symptoms. Results COX univariate analysis revealed that failure to take steroid immediately after operation(OR=2.914,P=0.000),infection after operation(OR=3.441,P=0.000).only taking anticholinesterase drugs after operation(OR=5.947,P=0.000),and immediately stopping medicine use or decreasing the dose of medicine within 1-3 months after the remission of symptoms(OR= 2.242,P=0.000) were prognostic factors for postoperative recurrence. On the other hand.multivariate logistic regression analysis revealed that infection after operation(OR=47.63,P=0.000),only taking anticholinesterase drugs after operation(OR=62.38,P=0.000),and stopping medicine or decreasing the dose of medicine 1-3 months after remission of symptoms(OR=32.76,P=0.000)were indeDendent influencing factors of recurrence after operation. Conclusion Post-operative infection, onlv taking PYridostigmine,and stopping medicine too early are independent factors of postoperative relapse.Regular treatment and timely use of adrenocortieal hormone decrease the recurrence after operation.