中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

胸腺扩大切除术与单纯药物治疗非胸腺瘤重症肌无力的疗效对比研究

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目的 分析研究胸腺扩大切除术和单纯药物两种治疗方式治疗非胸腺瘤重症肌无力的远期治疗效果及其影响因素。 方法 回顾性分析 2009 年 12 月至 2017 年 4 月在我院胸外科或神经内科确诊并治疗的非胸腺瘤重症肌无力 197 例患者的临床资料。根据美国重症肌无力联盟(MGFA)标准评价治疗效果,利用 Kaplan-Meier 分析绘制生存曲线评价缓解率及生存率,采用卡方检验和 Cox 比例风险回归分析治疗效果的影响因素。 结果 共随访到 174 例非胸腺瘤重症肌无力患者,中位随访时间为 31.7 个月,其中胸腺扩大切除术治疗(手术组)91 例,单纯药物治疗(单纯药物组)83 例。手术组完全缓解 29 例(31.9%),单纯药物组完全缓解 13 例(15.7%),差异有统计学意义(P=0.014)。进一步分析治疗方式(P=0.018)和重症肌无力分型(P=0.021)是影响治疗效果的主要因素。 结论 对于非胸腺瘤重症肌无力患者,胸腺扩大切除术治疗组在完全缓解率方面明显优于单纯药物治疗组,且前者术后免疫抑制剂的使用比例要明显低于后者。

Objective To assess the long-term results and relevant influencing factors of extended thymectomy and medicine-alone treatment of non-thymomatous myasthenia gravis(MG) patients. Methods A total of 197 non-thymomatous MG patients were reviewed in the study. The efficacy was evaluated according to the American Federation of myasthenia gravis (MGFA). Survival curves of the patients were plotted using the Kaplan-Meier method to evaluate the remission rate and survival rate. Cox regression analysis was put to use for multivariate analysis to assess the independent influence of the parameters. Results There were 174 patients with non-thymomatous MG were reported with a median time of 31.7 months in this study. In which, 91 patients were treated with extended thymectomy, while 83 patients with medicine-alone therapy. As a result, 29 patients (31.9%) achieved complete remission in the extended thymectomy group and 13 patients (15.7%) were completely relieved in the medicine-alone group, and the two sets were statistically significant (P=0.014). Further analysis shown that treatment (P=0.018) and MGFA type (P=0.021) were the main factors related to the efficacy. Conclusion For patients with non-thymomatous myasthenia gravis, extended thymectomy is superior to the medicine-alone in term of complete remission rate and the postoperative immunosuppression ratio of surgery group is significantly lower than medicine group.

关键词: 非胸腺瘤重症肌无力; 胸腺扩大切除术; 单纯药物治疗; 保守治疗; 疗效

Key words: Non-thymomatous myasthenia gravis; extended thymectomy; medicine-alone treatment; conservative treatment; efficac

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1. 中国免疫学会神经免疫学分会, 中华医学会神经病学分会神经免疫学组. 重症肌无力诊断和治疗中国专家共识. 中国神经免疫学和神经病学杂志, 2012, 19(6): 401-408.
2. Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: Executive summary. Neurology, 2016, 87(4): 419-425.
3. Hughes T. The early history of myasthenia gravis. Neuromuscul Disord, 2005, 15(12): 878-886.
4. 中华医学会神经病学分会, 神经免疫学组中国免疫学会神经免疫学分会. 中国重症肌无力诊断和治疗指南2015. 中华神经科杂志, 2015, 48(11): 934-940.
5. Jaretzki A 3rd, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg, 2000, 70(1): 327-334.
6. 蒋雷. 胸腺切除术治疗非胸腺瘤重症肌无力的研究进展. 中国胸心血管外科临床杂志, 2013, 20(4): 463-466.
7. Lucchi M, Van Schil P, Schmid R, et al. Thymectomy for thymoma and myasthenia gravis. A survey of current surgical practice in thymic disease amongst EACTS members. Interact Cardiovasc Thorac Surg, 2012,14(6):765-770.
8. Jaretzki A 3rd, Penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg, 1988, 95(5): 747-757.
9. Miller RG, Filler-Katz A, Kiprov D, et al. Repeat thymectomy in chronic refractory myasthenia gravis. Neurology, 1991, 41(6): 923-924.
10. Masaoka A, Monden Y, Seike Y, et al. Reoperation after transcervical thymectomy for myasthenia gravis. Neurology, 1982, 32(1): 83-85.
11. Taioli E, Paschal PK, Liu B, et al. Comparison of conservative treatment and thymectomy on myasthenia gravis outcome. Ann Thorac Surg, 2016, 102(6): 1805-1813.
12. Aydin Y, Ulas AB, Mutlu V, et al. Thymectomy in myasthenia gravis. Eurasian J Med, 2017, 49(1): 48-52.
13. Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
14. Bachmann K, Burkhardt D, Schreiter I, et al. Thymectomy is more effective than conservative treatment for myasthenia gravis regarding outcome and clinical improvement. Surgery, 2009, 145(4): 392-398.
15. Spillane J, Hayward M, Hirsch NP, et al. Thymectomy: role in the treatment of myasthenia gravis. J Neurol, 2013, 260(7): 1798-1801.
16. Bachmann K, Burkhardt D, Schreiter I, et al. Long-term outcome and quality of life after open and thoracoscopic thymectomy for myasthenia gravis: analysis of 131 patients. Surg Endosc, 2008, 22(11): 2470-2477.
17. Kerty E, Elsais A, Argov Z, et al. EFNS/ENS Guidelines for the treatment of ocular myasthenia. Eur J Neurol, 2014, 21(5): 687-693.
18. Roberts PF, Venuta F, Rendina E, et al. Thymectomy in the treatment of ocular myasthenia gravis. J Thorac Cardiovasc Surg, 2001, 122(3): 562-568.
19. Mineo TC, Ambrogi V. Outcomes after thymectomy in class I myasthenia gravis. J Thorac Cardiovasc Surg, 2013, 145(5): 1319-1324.
20. 邓艳, 张旭. 胸腺切除术治疗眼肌型重症肌无力的疗效观察及影响因素分析. 中国神经免疫学和神经病学杂志, 2009, 16(2): 86-89.
21. Zhu K, Li J, Huang X, et al. Thymectomy is a beneficial therapy for patients with non-thymomatous ocular myasthenia gravis: a systematic review and meta-analysis. Neurol Sci, 2017, 38(10): 1753-1760.
22. Zhong Y, Zhou Y, Jiang L, et al. Modified transsubxiphoid thoracoscopic extended thymectomy in patients with myasthenia gravis. Thorac Cardiovasc Surg, 2017, 65(3): 250-254.
23. Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial results. Eur J Cardiothorac Surg, 2016, 49 Suppl 1: i54-i58.
24. Nair AG, Patil-Chhablani P, Venkatramani DV, et al. Ocular myasthenia gravis: a review. Indian J Ophthalmol, 2014, 62(10): 985-991.
25. 王维治, 刘卫彬. 重症肌无力管理国际共识(2016)解读. 中华神经科杂志, 2017, 50(2): 83-87.