CAJ | 학술논문

目的：对青少年重症肌无力（ JMG）行冰冷试验观察睑裂宽度是否有变化，探讨冰冷试验在诊断JMG中的应用价值。方法以具有上睑下垂体征的临床确诊的、住院的JMG和非重症肌无力（ MG）患儿为研究对象，新斯的明试验后24 h再行冰冷试验，对试验前后睑裂宽度进行测量，睑裂宽度较试验前增加≥2 mm为阳性，计算冰冷试验2 min和5 min的敏感度和特异度。结果符合本文纳入和排除标准的JMG和非MG患儿分别为29和6例。JMG组（眼肌型MG 28例）中位年龄5.5岁；非MG组中位年龄6.2岁。JMG组新斯的明试验（30 min）27例阳性，2例至60 min依然阴性，冰冷试验2 min和5 min时分别有18和21例阳性。非MG组新斯的明试验和冰冷试验均阴性。新斯的明试验不良反应有腹痛、恶心、出汗和呕吐，冰冷试验不良反应有上眼睑略红。敏感度：冰冷试验2 min和5 min分别为62.1%和72.4%，新斯的明试验为93.1%；特异度均为100%。冰冷试验2 min和5 min的敏感度均与新斯的明试验差异有统计学意义。结论冰冷试验操作简单且安全，对疑似JMG的上睑下垂患儿先行冰冷试验（5 min），约70%试验呈阳性的患儿可代替新斯的明试验，冰冷试验（5 min）丰富了JMG辅助诊断手段。
목적：대청소년중증기무력（ JMG）행빙랭시험관찰검렬관도시부유변화，탐토빙랭시험재진단JMG중적응용개치。방법이구유상검하수체정적림상학진적、주원적JMG화비중증기무력（ MG）환인위연구대상，신사적명시험후24 h재행빙랭시험，대시험전후검렬관도진행측량，검렬관도교시험전증가≥2 mm위양성，계산빙랭시험2 min화5 min적민감도화특이도。결과부합본문납입화배제표준적JMG화비MG환인분별위29화6례。JMG조（안기형MG 28례）중위년령5.5세；비MG조중위년령6.2세。JMG조신사적명시험（30 min）27례양성，2례지60 min의연음성，빙랭시험2 min화5 min시분별유18화21례양성。비MG조신사적명시험화빙랭시험균음성。신사적명시험불량반응유복통、악심、출한화구토，빙랭시험불량반응유상안검략홍。민감도：빙랭시험2 min화5 min분별위62.1%화72.4%，신사적명시험위93.1%；특이도균위100%。빙랭시험2 min화5 min적민감도균여신사적명시험차이유통계학의의。결론빙랭시험조작간단차안전，대의사JMG적상검하수환인선행빙랭시험（5 min），약70%시험정양성적환인가대체신사적명시험，빙랭시험（5 min）봉부료JMG보조진단수단。
Objective To observe changes of palpebral fissure of non-invasive ice pack test in children with juvenile myasthenia gravis( JMG),and evaluate the diagnostic value of ice pack test in JMG. Methods The patients with ptosis were divided into JMG group and non-myasthenic gravis( MG)group. palpebral fissures of the patients with ptosis in two groups were measured before and 2 min and 5 min immediately after ice pack test which was performed 24 h after neostigmine test for 60 min at 20℃ -25℃. The changes of palpebral fissures relative to baseline great than 2 mm were consideed positive. The sensitivity and specificity of ice pack test(2 min and 5 min)and neostigmine test to the diagnosis of JMG were compared. Results ①There were 29 cases of JMG(1 case of generalised myasthenia gravis and 28 cases of ocular myasthenia gravis)in JMG group and 6 cases of non-MG in control group. The median age of JMG group and non-MG group was 5. 5 years old and 6. 2 years old,respectively. ②In JMG group,27 cases were positive at 30 min,and 2 cases were negative at 60 min during neostigmine test. The positive results of ice pack test were abserved in 18 and 21 cases at 2 min and 5 min,respectively. ③In non-MG group,there was only 1 case whose palpebral fissure changes of ice pack test for 2 min,ice pack test for 5 min was 1 mm. There were no palpebral fissure changes in 5 cases.④The sensitivities of ice pack test for 2 min,ice pack test for 5 min and neostigmine test were 62. 1%,72. 4%and 93. 1%,respectively. All of the specificities of ice pack test and neostigmine test were all 100%. There were significant differences between the ice pack test for 2 min and neostigmine test,the ice pack test for 5 min and neostigmine test respectively.⑤There were 4 cases with abdominal pain,3 cases with nausea,3 cases with sweating and 2 cases with vomiting during the neostigmine test. The skin of the upper eyelid of 6 cases turned red slightly. Conclusion The high sensitivity and specificity of ice pack test for 5 min,as well as the rapid,simple,safe,cheap and woundless characteristics make it benefit to the diagnosis of ptosis of JMG.