CAJ | 학술논문

目的分析胸腺切除治疗重症肌无力(MG)近期疗效及危象发生的影响因素.方法回顾性分析436例胸腺切除治疗重症肌无力患者,对年龄、性别、病程、临床分型、胸腺病理类型、胸腺瘤病理分期、胸腺瘤病理类型等因素进行统计分析.结果 Ⅰ型患者术后近期症状稳定的比例较高[62.63%(186/297)],而ⅡA型以上患者术后近期改善及恶化的比例均较高,其差异有统计学意义(均为P＜0.05);各性别、年龄、病程、病理类型、胸腺瘤分期、胸腺瘤病理类型亚组间近期疗效差异无统计学意义(均为P＞0.05).Logistic回归分析显示,有无胸腺瘤(回归系数0.251)及肌无力分型(回归系数1.300)两个因素与术后危象发生有关(均为P＜0.05);伴有胸腺瘤的患者、ⅡA型以上患者术后发生危象概率明显偏高.结论临床分型在ⅡA型以上MG患者术后近期症状易出现波动;患者性别、年龄、病程、病理类型、胸腺瘤分期、胸腺瘤病理类型与近期疗效无关;伴有胸腺瘤的MG患者、ⅡA型以上患者是术后危象发生的高危人群,术前要充分估计风险,围术期注意预防.
목적 분석흉선절제치료중증기무력(MG)근기료효급위상발생적영향인소.방법 회고성분석436례흉선절제치료중증기무력환자,대년령、성별、병정、림상분형、흉선병리류형、흉선류병리분기、흉선류병리류형등인소진행통계분석.결과 Ⅰ형환자술후근기증상은정적비례교고[62.63%(186/297)],이ⅡA형이상환자술후근기개선급악화적비례균교고,기차이유통계학의의(균위P＜0.05);각성별、년령、병정、병리류형、흉선류분기、흉선류병리류형아조간근기료효차이무통계학의의(균위P＞0.05).Logistic회귀분석현시,유무흉선류(회귀계수0.251)급기무력분형(회귀계수1.300)량개인소여술후위상발생유관(균위P＜0.05);반유흉선류적환자、ⅡA형이상환자술후발생위상개솔명현편고.결론 림상분형재ⅡA형이상MG환자술후근기증상역출현파동;환자성별、년령、병정、병리류형、흉선류분기、흉선류병리류형여근기료효무관;반유흉선류적MG환자、ⅡA형이상환자시술후위상발생적고위인군,술전요충분고계풍험,위술기주의예방.
Objective To investigate the short-term efficacy of thymectomy and crisis risk factors in patients with myasthenia gravis (MG). Methods A retrospective review of 436 patients with myasthenia gravis treated by thymectomy was conducted, with statistical analysis on age, gender, duration of disease,clinical classification, pathology and pathological staging. Results Patients with clinical class Ⅰ disease were more stable in short-term symptoms (62.63%, 186/297), whereas those with clinical class Ⅱ A or above experienced more short-term improvement or deterioration (both P＜0.05). Significant differences in gender,age, duration of disease, pathology, pathological staging and pathologic subgroups of thymoma were not identified (P＞0.05). Logistic regression showed that incidence of post-surgical crisis was associated to thymoma (r=0.251, P＜0.05) and clinical classification (r=1.300, P＜0.05). The patients with thymoma or clinical classification over Ⅱ A had a higher chance for post-surgical crisis. Conclusions Instability in shortterm symptoms is more likely to occur in MG patients with clinical class Ⅱ A and above. Short-term efficacy is not associated with gender, age, duration of disease, pathologic types of thymus, pathological classification of thymoma, and pathologic types of thymoma. Patients with thymoma or clinical class Ⅱ A and above can be a high-risk population for post-surgical crisis, suggesting a need for thorough pre-surgical evaluation of risks and precaution during the perioperative period.