多西他赛联合顺铂与大量糖皮质激素冲击治疗复发胸腺瘤合并重症肌无力的疗效比较

目的：比较多西他赛联合顺铂与大量糖皮质激素冲击治疗胸腺瘤切除术后胸腺瘤复发合并重症肌无力（MG）患者的临床疗效。方法：选取2013年1月-2015年1月就诊于某院的32例胸腺瘤切除术后胸腺瘤复发合并重症肌无力患者。其中，20例患者接受多西他赛联合顺铂治疗（DP组），12例患者采用大量糖皮质激素冲击治疗。对比观察2组患者治疗前后乙酰胆碱受体抗体（acetylcholine receptor antibody，AchR-Ab）和临床绝对评分（clinic definitely score，CDS）的变化，并记录化疗不良反应的发生。结果： 2组患者的AchR-Ab水平及CDS分别与治疗前相比，治疗后均显著改善，差异有统计学意义（P<0.05）。大量激素冲击组治疗肌无力有效率为97.7%，DP组治疗肌无力有效率为95.0%，2组患者MG治疗的疗效差异无统计学意义（P>0.05）。大量激素冲击组治疗胸腺瘤显效率为75.0%，DP组治疗胸腺瘤显效率为30.0%。2组方案胸腺瘤治疗的疗效差异有统计学差异（P<0.05）。大量激素冲击组患者不良反应的发生率为66.7%，而DP组为25.0%。结论：大量糖皮质激素冲击对复发胸腺瘤合并MG的肌无力和胸腺瘤两方面疗效显著，但不良反应大。多西他赛联合顺铂对复发胸腺瘤合并MG的肌无力疗效显著，同时不良反应小，但对胸腺瘤方面作用不明显。

Comparison of therapeutic effects of docetaxel combined with cisplatin and glucocorticoid in the treatment of recurrent thymoma associated with myasthenia gravis

OBJECTIVE To compare the therapeutic effects of steroid pulse therapy and docetaxel combined with cisplatin in myasthenia gravis (MG) patients with recurrent thymoma.METHODS Totally 32 myasthenia gravis (MG) patients with recurrent thymoma were followed up, who underwent resection of thymoma in a hospital from January 2013 to January 2015. Among them, 20 patients were treated by docetaxel combined with cisplatin (DP group), and 12 patients were treated by glucocorticoid therapy. The changes of acetylcholine receptor antibody (AchR-Ab) and clinical absolute score (CDS) were observed and recorded before and after treatment in two groups.RESULTS Two groups of patients had AchR-Ab and CDS significantly improved after treatment (P<0.05). The effective rate against myasthenia gravis was 97.7% in steroid pulse therapy group, and 95.0% in DP group (P>0.05). The effective rate against thymoma was 75.0%, in steroid pulse therapy group, and 30.0% in DP group (P<0.05). The incidence of side effects was 66.7% in the steroid group, about 25.0% in the DP group.CONCLUSION The effect of glucocorticoid pulse therapy is significant in patients with recurrent thymoma combined myasthenia gravis or thymoma, but the side effects were also serious. Docetaxel combined with cisplatin has significant effects against recurrent thymoma combined MG, with less side effects, but the combined therapy has no significant effects against thymoma.