Ocular myasthenia gravis: treatment successes and failures in patients with long-term follow-up
Ocular myasthenia gravis: treatment successes and failures in patients with long-term follow-up
复制标题
DOI：
10.1007/s00415-009-5120-8
复制
发表时间：
2009-08-01
影响因子：
6
通讯作者：
Kupersmith, Mark J.
中科院分区：
文献类型：
--
作者：
Kupersmith, Mark J.
我们以前曾报道，泼尼松减少全身性肌无力（GMG）的频率和控制复视没有重大的不良反应，在2年的眼肌型重症肌无力（OMG）患者。问题仍然是研究对象是否有长期的疾病，偏向于类固醇的好处，如果泼尼松只是延迟GMG发作的结果。在这里，我们进行了一个记录审查的转诊神经眼科服务OMG数据库的患者进行了随访的千分之一日元4年或直到GMG发展。我们研究了泼尼松对GMG发病率和眼部症状控制的影响。复视患者一般建议使用强的松治疗。大多数患者保持每日2.5-10 mg，以控制复视。我们比较了泼尼松治疗和“未治疗”（仅吡啶斯的明）患者的结果。在87例患者中，55例为泼尼松治疗组，32例为未治疗组。泼尼松治疗组7例（13%）发生GMG（OR 0.41; 95%CI 0.22-0.76），未治疗组16例（50%）发生GMG（OR 2.78; 95%CI 1.68-4.60）。在OMG发病后，GMG在泼尼松组和未治疗组中平均发生时间分别为5.8和0.22年。27%的泼尼松治疗组（平均7.2年）和57%的未治疗组（平均4.6年）OMG患者在末次检查时存在复视。在48例未发生GMG的泼尼松治疗患者中，13例发生OMG治疗失败。因此，泼尼松可延迟GMG的发作，并在降低GMG的发生率和控制复视方面具有持续的益处。如果没有泼尼松，GMG在50%的OMG患者中发展，通常在1年内。
We previously reported that prednisone reduced the frequency of generalized myasthenia (GMG) and controlled diplopia without major adverse effects at 2 years in patients with ocular myasthenia gravis (OMG). Questions remain as to whether study subjects had long-standing disease, biasing results towards a steroid benefit, and if prednisone merely delayed GMG onset. Here, we performed a record review of a referral neuro-ophthalmology service OMG database for patients who were followed-up for a parts per thousand yen4 years or until GMG developed. We studied the effect of prednisone on GMG incidence and control of ocular symptoms. Generally, patients with diplopia were recommended for prednisone therapy. Most remained on daily 2.5-10 mg for diplopia control. We compared the results for prednisone-treated and "untreated" (pyridostigmine only) patients. Of 87 patients, 55 were in the prednisone-treated and 32 were in the untreated groups. GMG developed in 7 (13%) of the prednisone-treated (OR 0.41; 95% CI 0.22-0.76) and in 16 (50%) of the untreated (OR 2.78; 95% CI 1.68-4.60) patients. After OMG onset, GMG developed at a mean 5.8 and 0.22 years in prednisone and untreated groups. Diplopia was present at the last exam in 27% of the prednisone-treated (mean 7.2 years) and in 57% of the untreated (mean 4.6 years) OMG patients. For 48 prednisone-treated patients who did not develop GMG, OMG treatment failure occurred in 13. Thus, prednisone delays the onset of GMG and has sustained benefit in reducing the incidence of GMG and controlling diplopia. Without prednisone, GMG develops in 50% of OMG patients, typically within 1 year.