CAJ | 학술논문

目的：比较乙酰胆碱受体抗体(AChR-Ab)阳性全身型重症肌无力(MG)与AChR-Ab阴性全身型MG患者胸腺切除术的疗效。方法将124例于胸外科接受胸腔镜胸腺扩大切除术的全身型MG患者，根据术前血清AChR -Ab表现，分为AChR-Ab阳性组(81例)和AChR-Ab阴性组(43例)，比较两组患者的完全稳定缓解率。结果两组患者的性别、手术时年龄、术前病程、首发症状及胸腺病理类型等基本情况组间比较差异无显著性。术后AChR-Ab阳性组失访1例，阴性组失访2例，共完成随访121例患者，随访时间15~84个月，其中AChR-Ab阳性组80例，随访(44.9±19.9)个月， AChR-Ab阴性组41例，随访(48.2±20.3)个月。术后完全稳定缓解率AChR-Ab阳性组(48.8%)显著高于AChR-Ab阴性组(26.8%)，χ2=5.372，P=0.020。术后总有效率AChR-Ab阳性组为95.0%，AChR-Ab 阴性组为90.2%，两组比较差异无统计学意义(χ2=0.993，P=0.319)。完全稳定缓解率的Kaplan-Meier生存曲线提示，随着术后随访时间的延长，完全稳定缓解率逐渐升高；Log-rank法比较两组之间的完全稳定缓解率均逐渐升高(P=0.03)。结论血清AChR-Ab阳性患者胸腺扩大切除术后完全稳定缓解率优于AChR-Ab阴性患者，随着随访时间的延长，完全稳定缓解率逐渐升高，但两组患者的总有效率类似。
목적：비교을선담감수체항체(AChR-Ab)양성전신형중증기무력(MG)여AChR-Ab음성전신형MG환자흉선절제술적료효。방법장124례우흉외과접수흉강경흉선확대절제술적전신형MG환자，근거술전혈청AChR -Ab표현，분위AChR-Ab양성조(81례)화AChR-Ab음성조(43례)，비교량조환자적완전은정완해솔。결과량조환자적성별、수술시년령、술전병정、수발증상급흉선병리류형등기본정황조간비교차이무현저성。술후AChR-Ab양성조실방1례，음성조실방2례，공완성수방121례환자，수방시간15~84개월，기중AChR-Ab양성조80례，수방(44.9±19.9)개월， AChR-Ab음성조41례，수방(48.2±20.3)개월。술후완전은정완해솔AChR-Ab양성조(48.8%)현저고우AChR-Ab음성조(26.8%)，χ2=5.372，P=0.020。술후총유효솔AChR-Ab양성조위95.0%，AChR-Ab 음성조위90.2%，량조비교차이무통계학의의(χ2=0.993，P=0.319)。완전은정완해솔적Kaplan-Meier생존곡선제시，수착술후수방시간적연장，완전은정완해솔축점승고；Log-rank법비교량조지간적완전은정완해솔균축점승고(P=0.03)。결론혈청AChR-Ab양성환자흉선확대절제술후완전은정완해솔우우AChR-Ab음성환자，수착수방시간적연장，완전은정완해솔축점승고，단량조환자적총유효솔유사。
Aim To compare the clinical outcome of the post-thymectomy between generalized myasthenia gravis (gMG) with acetylcholine receptor antibody (AChR-Ab) positive and AChR-Ab negative. Methods124 cases of gMG who were retrospectively reviewed had received video-assisted thoracoscopic thymectomy in the thoracic surgery. According to the type of the serum antibodies, the patients were divided in to AChR-Ab-positive group and AChR-Ab-negative group. The primary endpoint was to assess differences in the rate of complete stable remission (CSR) in patients in the two groups.ResultsThere were 81 patients in the AChR-Ab positive group, and 43 patients in AChR-Ab-negative group, there was no signiifcant difference among the three groups regarding sex, age at onset and disease duration, and thymus pathology. One case in AChR-Ab-positive group was lost, two cases in AChR-Ab-negative group were lost. Until the deadline of follow-up time of Sep. 2014, a total of 121 patients were followed, including 80 cases in AChR-Ab-positive group, 41 cases in AChR-Ab-negative group. Follow-up time was 15 to 84 months, mean (44.9±19.9) months in AchR-Ab positive group, mean (48.2±20.3) months in AChR-Ab-negative group. The complete stable remission rate (CSR) in AChR-Ab-positive group was 48.8%, in the AChR-Ab-negative group theP vaule was 26.8%. The CSR in the AChR-Ab-positive group was higer than that in the AChR-Ab-negative group [(χ2=5.372,P=0.020)]. The overall remission rate in the AChR-Ab-positive group was 85.1%, and 73.2% in the AChR-Ab-negative. There was no signiifcant difference in the overall remission rate between the two group. By Kaplan–Meier analysis, there was signiifcant difference in CSR rates between AChR-Ab-positive group and AChR-Ab-negative group (P=0.03).Conclusion Long-term post-thymectomy clinical outcome was better in AChR-Ab-positive group than in AChR-Ab-negative group, but our results showed no differences in the overall remission rate.