眼肌型重症肌无力的预后分析

目的探讨影响眼肌型重症肌无力(myasthenia gravis,MG)临床预后的相关因素。方法回顾性分析2008年7月至2010年9月我院收治的203例眼肌型MG患者,根据治疗后6～32个月临床预后分为完全缓解组及未完全缓解组。比较两组MG患者的临床特点,分析单纯胆碱酯酶抑制剂,胆碱酯酶抑制剂合并胸腺切除术或糖皮质激素三种方法对眼肌型MG预后有无影响。结果 203例眼肌型MG患者87(42.86%)例完全缓解。两组患者中病程2年者完全缓解率为58.52%,明显高于病程﹥2年者的缓解率29.41%(P0.01)。临床表现仅为眼睑下垂者完全缓解率显著高于伴有复视者(48.7%vs.34.53%,P0.01):单用胆碱酯酶抑制剂治疗完全缓解率为46.25%,胆碱酯酶抑制剂+糖皮质激素治疗为38.18%,胆碱酯酶抑制剂+胸腺切除治疗为42.65%。统计学分析,三种不同治疗方案对眼肌型MG预后无显著统计学差异。结论眼肌型MG完全缓解率随着病程的延长明显下降。胆碱酯酶抑制剂,糖皮质激素及胸腺切除术对眼肌型MG完全缓解率无明显影响。

Prognostic analysis of ocular myasthenia gravis

Objective To analyze the prognostic factors of the patients with ocular myasthenia gravis(MG) and to compare the therapeutic effects of acetylcholinesterase inhibitor,corticosteroid or thymectomy on this type of patients.Methods We performed a retrospective analysis for 203 ocular MG patients admitted to the department during the same period(2008.7-2010.9).The patients with MG followed up for 6-32months were divided into two subgroups according to their prognosis,which were the complete stable remission group(n=87) and incomplete remission group(n=116).Clinical characteristics including sex,age,duration,clinical symptom,repetitive nerve stimulation(RNS) tests and thymic abnormalities and clinical remission treated with acetylcholinesterase inhibitor alone and combined with corticosteroid or thymectomy were compared between the two groups.Results Eight-seven(42.86%) of the 203 study subjects were in full remission.There were no significant differences in the initial age,sex,the positive rates of RNS and thymic abnormalities between the two groups.But the variables correlated to complete remission were the disease duration and clinical symptoms of extra ocular muscles weakness.In the complete remission groups,the patients with ptosis signs only and the disease duration within 2 years were significantly higher than those in the incomplete remission group.The full remission rates in those patients received acetylcholinesterase inhibitor alone,combined with corticosteroid or thymectomy were 46.25%,38.18%,42.65%,respectively.And statistical analysis showed that there were no significant differences among the three treatment subgroups.Conclusions Our findings suggest that factors including the disease duration and extraocular weakness signs may be related on complete stable remission outcomes.Acetylcholinesterase inhibitor alone and combined with corticosteroid or thymectomy have no statistical difference on the rate of full remission of ocular MG.d combined with corticosteroid or thymectomy had no statistical difference on the rate of full remission of ocular MG.