中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2014年
5期
327-330
,共4页
重症肌无力%眼肌麻痹%新斯的明
重癥肌無力%眼肌痳痺%新斯的明
중증기무력%안기마비%신사적명
Myasthenia gravis%Ophthalmoplegia%Neostigmine
目的 观察新斯的明试验在眼外肌起病的重症肌无力(myasthenia gravis,MG)诊断中的应用现状,包括试验方法和结论分析.方法 对2012年1-12月于我院就诊的以眼外肌起病的100例MG患者进行回顾性研究,对患者进行登记注册和随诊,包括首发症状、症状演变、就诊次数和专科、新斯的明肌肉注射试验应用的方法学和结果判断等.结果 (1)本组MG患者均以单眼睑下垂或双眼睑下垂、复视起病,其中46％ (46/100)有眼睑下垂伴有复视.其中21％ (21/100)在新斯的明试验前已出现眼外肌以外的症状.78％ (78/100)的患者会首选眼科就诊,首次就诊的时间为(0.7±0.3)个月.首次神经科就诊的时间为(1.6±1.3)个月,从发病至诊断的时间(3.3±2.1)个月.(2)首次新斯的明试验为神经科就诊(2.0±1.5)次时进行,距发病时间(2.0±1.8)个月.低剂量的肌肉注射新斯的明试验阳性率较规范的新斯的明肌肉注射试验阳性率低[60.9％(14/23)与98.3％(58/59),x2=18.30,P＜0.01],口服溴吡斯的明试验性治疗阳性率低于肌肉注射新斯的明试验[15/18与98.3％(58/59),x2=4.428,P=0.035].(3)新斯的明试验不良反应达65％(65/100),但均为轻度至中度.结论 对眼外肌麻痹的MG患者新斯的明试验的不规范应用会降低新斯的明试验的阳性发现,应重视规范化的新斯的明肌肉注射试验.
目的 觀察新斯的明試驗在眼外肌起病的重癥肌無力(myasthenia gravis,MG)診斷中的應用現狀,包括試驗方法和結論分析.方法 對2012年1-12月于我院就診的以眼外肌起病的100例MG患者進行迴顧性研究,對患者進行登記註冊和隨診,包括首髮癥狀、癥狀縯變、就診次數和專科、新斯的明肌肉註射試驗應用的方法學和結果判斷等.結果 (1)本組MG患者均以單眼瞼下垂或雙眼瞼下垂、複視起病,其中46％ (46/100)有眼瞼下垂伴有複視.其中21％ (21/100)在新斯的明試驗前已齣現眼外肌以外的癥狀.78％ (78/100)的患者會首選眼科就診,首次就診的時間為(0.7±0.3)箇月.首次神經科就診的時間為(1.6±1.3)箇月,從髮病至診斷的時間(3.3±2.1)箇月.(2)首次新斯的明試驗為神經科就診(2.0±1.5)次時進行,距髮病時間(2.0±1.8)箇月.低劑量的肌肉註射新斯的明試驗暘性率較規範的新斯的明肌肉註射試驗暘性率低[60.9％(14/23)與98.3％(58/59),x2=18.30,P＜0.01],口服溴吡斯的明試驗性治療暘性率低于肌肉註射新斯的明試驗[15/18與98.3％(58/59),x2=4.428,P=0.035].(3)新斯的明試驗不良反應達65％(65/100),但均為輕度至中度.結論 對眼外肌痳痺的MG患者新斯的明試驗的不規範應用會降低新斯的明試驗的暘性髮現,應重視規範化的新斯的明肌肉註射試驗.
목적 관찰신사적명시험재안외기기병적중증기무력(myasthenia gravis,MG)진단중적응용현상,포괄시험방법화결론분석.방법 대2012년1-12월우아원취진적이안외기기병적100례MG환자진행회고성연구,대환자진행등기주책화수진,포괄수발증상、증상연변、취진차수화전과、신사적명기육주사시험응용적방법학화결과판단등.결과 (1)본조MG환자균이단안검하수혹쌍안검하수、복시기병,기중46％ (46/100)유안검하수반유복시.기중21％ (21/100)재신사적명시험전이출현안외기이외적증상.78％ (78/100)적환자회수선안과취진,수차취진적시간위(0.7±0.3)개월.수차신경과취진적시간위(1.6±1.3)개월,종발병지진단적시간(3.3±2.1)개월.(2)수차신사적명시험위신경과취진(2.0±1.5)차시진행,거발병시간(2.0±1.8)개월.저제량적기육주사신사적명시험양성솔교규범적신사적명기육주사시험양성솔저[60.9％(14/23)여98.3％(58/59),x2=18.30,P＜0.01],구복추필사적명시험성치료양성솔저우기육주사신사적명시험[15/18여98.3％(58/59),x2=4.428,P=0.035].(3)신사적명시험불량반응체65％(65/100),단균위경도지중도.결론 대안외기마비적MG환자신사적명시험적불규범응용회강저신사적명시험적양성발현,응중시규범화적신사적명기육주사시험.
Objective To investigate the usage of neostigmine test in diagnosis of myasthenia gravis (MG) initiated from extraocular muscles,including test methods and data analysis.Methods The clinical features of 100 consecutive patients with myasthenia gravis initiated from extraocular muscles were collected retrospectivelly,including initial symptom,number and department of visiting,evolution of symptoms and signs,methods and the judgment of therapeutic response for neostigmine test.Results (1) All patients with MG started from ptosis unilateral or bilateral or diplopia,among which 46％ (46/100)of patients with both ptosis and diplopia.Within 21％ (21/100) of patients,other muscles had been involved except for extrocular muscles before neostigmine test.Seventy-eight percent patients first consulted ophthalmology after (0.7 ± 0.3) month from onset.It took (1.6 ± 1.3) months for patients to visit neurologist for the first time.The average time for confirming diagnosis was (3.3 ± 2.1) months.(2) After (2.0 ± 1.5) times consulted at neurology department and (2.0 ± 1.8) months after symptoms onset,the patients undergone neostigmine test.Positive reaction rate showed lower in low dosage group (60.9％ (14/23) vs 98.3％ (58/59),x2 =18.30,P ＜0.01).Positive rate also showed lower in oral-take pyridostigmine bromide tablets group than neostigmine methylsulfate injection group(15/18 vs 98.3％ (58/59),x2 =4.428,P =0.035).(3) Sixtyfive percent patients had mild to moderate side effects after neostigmine injection,which disappeared in 60-120 minutes.Conclusions Non-standard operations of neostigmine test reduced the effectiveness of its diagnosis for MG initiated from extraocular muscles.Neurologist should attach importance totake standard neostigmine test to identify MG as soon as possible.
