Predictors of outcome of myasthenic crisis
Predictors of outcome of myasthenic crisis
复制标题
DOI：
10.1007/s10072-014-1659-y
复制
发表时间：
2014-07-01
影响因子：
3.3
通讯作者：
Misra, U. K.
中科院分区：
文献类型：
--
作者：
Kalita, J.;Kohat, A. K.;Misra, U. K.
关于重症肌无力危象（MC）、延长通气时间及其结局的预测因素的研究很少，这是进行本研究的原因。纳入64例重症肌无力（MG）患者，中位年龄为45（6-84）岁。记录他们的临床治疗、胸腺瘤、抗乙酰胆碱受体抗体（AchRAb）、胸腺切除术、合并症、违规药物和MC的发生。记录了需要长时间通气（> 15天）的患者。调查住院死亡率、出院时MG患者的生活质量（QOL）以及此后每年的住院次数、入院情况、费用支出和工作日损失。14例（21.9%）患者在发病后1-120个月（中位8.5个月）内发生MC，中位随访时间为48（3-264）个月。诱发因素为感染6例，手术5例，药物减量2例，碘造影剂反应1例。男性、延髓无力、AchRAb、胸腺瘤、手术和合并症与MC相关。其中8例（57.1%）需延长通气时间.半数MC患者有复发危象（2-4次发作）。死亡与MC无关，尽管MC患者的生活质量较差，每年的治疗费用较高，频繁的医院就诊和住院。总之，合并症与MC和长时间通气的相关性强调了密切随访和适当管理的必要性。
There is paucity of study on predictors of myasthenic crisis (MC), prolonged ventilation and their outcome, a reason why this study was undertaken. Sixty-four patients with myasthenia gravis (MG) were included whose median age was 45 (6-84) years. Their clinical treatment, presence of thymoma, anti-acetylcholine receptor antibody (AchRAb), thymectomy, comorbidities, offending drugs and occurrence of MC were noted. Patients needing prolonged ventilation (> 15 days) were noted. Hospital mortality, MG quality of life (QOL) at discharge and thereafter annual hospital visit, admission, expenditure and work day loss were enquired. Fourteen (21.9 %) patients had MC within 1-120 (median 8.5) months of disease onset within a median follow-up of 48 (3-264) months. The precipitating factors were infection in six, surgery in five, tapering of drugs in two and reaction to iodinated contrast in one patient. Male gender, bulbar weakness, AchRAb, thymoma, surgery and comorbid illnesses were related to MC. Eight of them (57.1 %) needed prolonged ventilation. Half the patients with MC had recurrent crisis (2-4 attacks). Death was not related to MC although MC patients had worse QOL, higher annual treatment expenditure with frequent hospital visit and hospitalization. In conclusion, association of comorbid illness with MC and prolonged ventilation highlights the need of close follow-up and appropriate management.