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 对比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 174 例非胸腺瘤重症肌无力患者的临床资料,其中男 81 例、女 93 例,年龄 13~88(47.1±17.8)岁。根据治疗方法的不同,将患者分为两组:手术组(胸腺扩大切除术治疗)91 例,单纯药物组(单纯药物治疗)83 例。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 比例风险回归模型分析治疗效果的影响因素。 结果 随访 3~94(39.1±26.9)个月。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)。通过进一步分析发现,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 We retrospectively analyzed the clinical data of 174 patients with non-thymomatous MG diagnosed and treated in our department from December 2009 to April 2017, including 81 males and 93 females, aged 13-88 (47.1±17.8) years. According to the different treatment methods, the patients were divided into two groups: an operation group (91 patients receiving extended thymectomy) and a medicine-alone group (83 patients receiving medical therapy alone). The efficacy was evaluated according to the Myasthenia Gravis Foundation of America (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 used to assess the influencing factors of the outcomes. Results The patients were followed up for 3 to 94 (39.1±26.9) months. As a result, 29 patients (31.9%) achieved complete remission in the surgery group and 13 patients (15.7%) were completely relieved in the medicine-alone group (P=0.014). Further analysis showed that treatment pattern (P=0.018) and MG type (P=0.021) were the main factors related to the efficacy. Conclusion For patients with non-thymomatous MG, extended thymectomy is superior to the medicine-alone in terms of complete remission rate and the postoperative immunosuppression ratio.

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; efficacy

引用本文: 田笑如, 钱坤, 王若天, 苏雷, 张毅. 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. 中国胸心血管外科临床杂志, 2018, 25(9): 772-776. doi: 10.7507/1007-4848.201710051 复制

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