环磷酰胺治疗93例重症肌无力伴胸腺瘤的疗效观察

目的 探讨环磷酰胺对重症肌无力伴胸腺瘤患者的治疗效果。 方法 选择2010年1月—2015年12月湖州市中心医院和浙江大学附属第二医院神经内科被诊断为重症肌无力伴胸腺瘤患者93例作为研究对象，根据胸腺瘤的恶性程度将其分为较低恶性胸腺瘤组(44例)和较高恶性胸腺瘤组(49例)。2组患者均给予环磷酰胺静滴治疗。比较较低恶性胸腺瘤组和较高恶性胸腺瘤组的一般情况、治疗前后重症肌无力临床评分、治疗效果以及不良反应情况。 结果 2组治疗前重症肌无力临床评分比较差异无统计学意义(P＞0.05)，2组治疗后重症肌无力临床评分比较差异无统计学意义(P＞0.05)；治疗后较低恶性胸腺瘤组的重症肌无力临床评分低于治疗前的重症肌无力临床评分，差异有统计学意义(P＜0.05)，治疗后较高恶性胸腺瘤组的重症肌无力临床评分低于治疗前的重症肌无力临床评分，差异有统计学意义(P＜0.05)，较低恶性胸腺瘤组和较高恶性胸腺瘤组的治疗有效率分别为88.6%和85.7%，2组比较差异无统计学意义(P＞0.05)，较低恶性胸腺瘤组的白细胞降低、转氨酶升高、乏力、恶心、呕吐的不良反应和较高恶性胸腺瘤组之间比较差异无统计学意义(P＞0.05)。 结论 环磷酰胺治疗重症肌无力伴胸腺瘤是安全有效的，对较低恶性胸腺瘤和较高恶性胸腺瘤重症肌无力患者的治疗效果没有差异。 

Therapeutic efficacy of cyclophosphamide on thymoma in patients with myasthenia gravis

Objective To investigate therapeutic efficacy of cyclophosphamide on thymoma in patients with myasthenia gravis. Methods From January,2010 to December,2015,93 cases of myasthenia gravis with thymoma in Huzhou Central Hospital and Second Affiliated Hospital were selected and divided into low malignant thymoma group(44 cases) and high malignant thymoma group(49 cases) according to the degree of thymoma malignancy.The patients in both groups received cyclophosphamide intravenous treatment.The general condition,the quantitative myasthenia gravis score,therapeutic efficacy and adverse reactions were compared between the two groups. Results The quantitative myasthenia gravis score between the two groups had no differences before and after the treatment(P>0.05).After the treatment,the quantitative myasthenia gravis score in both group L and group H were decreased(P<0.05).The curative effective rate in group L was 88.6% and in group H was 85.7%,the difference was not significant(P>0.05).There was no difference in the white blood cell count dropping,aminotransferases increasing,fatigue,nausea and vomiting between the two groups(P>0.05). Conclusion Cyclophosphamide is safe and effective in the treatment of thymoma in patients with myasthenia gravis with,the therapeutic efficacy is similar for low and high malignant thymoma.