Frequency of myasthenic crisis in relation to thymectomy in generalized myasthenia gravis: a 17-year experience.
Frequency of myasthenic crisis in relation to thymectomy in generalized myasthenia gravis: a 17-year experience.
复制标题
DOI：
10.1186/1471-2377-4-12
复制
发表时间：
2004-09-11
期刊：
影响因子：
2.6
通讯作者：
Soltanzadeh A
中科院分区：
文献类型：
--
作者：
Soleimani A;Moayyeri A;Akhondzadeh S;Sadatsafavi M;Tavakoli Shalmani H;Soltanzadeh A
肌无力危象是全身性重症肌无力(MG)患者最严重的生命危险事件。这项研究的目的是评估胸腺切除术对伊朗患者这些发作的发生率和严重程度的长期影响。我们回顾了1985年至2002年在我们神经科门诊诊断和治疗的272例肌无力患者的临床记录。排除53例因诊断不明、眼型、手术禁忌症、伴发疾病、失访等原因。使用Osserman分级法评估疾病的初始严重程度。根据变量的性质，用适当的统计检验对两组患者的发作频率和严重程度进行比较。多因素Logistic回归分析用于评估无胸腺瘤患者组肌无力危象的预测因素。胸腺切除组110例，内科治疗109例。两组在发病年龄、性别、基线和随访期的Osserman评分方面无显著差异。219例患者中有62例(28.3%)有89次肌无力危象发作。胸腺切除组20例(32%)，胸腺切除组42例(68%)。两组危象发生例数比较差异有统计学意义(P=0.001)，优势比为2.895%可信区间为1.5~5.2.另外，非胸腺切除患者的发作更为严重，因为他们住ICU的时间较长，发作时需要更多的机械支持。回归模型显示，胸腺切除和发病年龄较低是非胸腺瘤性MG患者肌无力危象发生率降低的两个预测因素。建议将肌无力发作的频度和严重程度作为评估MG患者的重要指标。胸腺切除术似乎对这些发作的发生率和严重程度有预防作用。
Myasthenic crisis is the most serious life-threatening event in generalized myasthenia gravis (MG) patients. The objective of this study was to assess the long-term impact of thymectomy on rate and severity of these attacks in Iranian patients. We reviewed the clinical records from 272 myasthenic patients diagnosed and treated in our neurology clinic during 1985 to 2002. Fifty-three patients were excluded because of unconfirmed diagnosis, ocular form of MG, contraindication to surgery, concomitant diseases and loss to follow-up. The Osserman classification was used to assess the initial severity of the disease. Frequency and severity of the attacks were compared between two groups with appropriate statistical tests according to the nature of variables. Multivariate logistic regression analysis was used to assess the predictors of myasthenic crisis in the group of patients without thymoma. 110 patients were in thymectomy group and the other 109 patients were on medical therapy. These two groups had no significant differences with respect to age at onset, gender, Osserman score in baseline and follow up period. 62 patients (28.3% of all 219 patients) had reported 89 attacks of myasthenic crisis. 20 patients of 62 (32%) were in thymectomy group and 42 (68%) were in the other group. There was significant difference between the two groups in number of patients with crisis (P = 0.001; odds ratio = 2.8 with 95% CI of 1.5 to 5.2). In addition, these attacks were more severe in group of non-thymectomized patients as the duration of ICU admission was longer and they needed more ventilatory support during their attacks. Regression model showed thymectomy and lower age at onset as two predictors of decrement in myasthenic crisis rate in non-thymomatous MG patients. It is suggested that frequency and severity of myasthenic attacks as important endpoints in evaluation of MG patients. Thymectomy seems to have a preventive role on rate and severity of these attacks.
登录
查看更多内容
影响因子：
4.6
作者：
Masaoka, A;Yamakawa, Y;Monden, Y
通讯作者：
Monden, Y
影响因子：
3.4
作者：
Venuta, F;Rendina, EA;Ricci, C
通讯作者：
Ricci, C
影响因子：
9
作者：
Bulkley, GB;Bass, KN;Drachman, DB
通讯作者：
Drachman, DB
影响因子：
4.6
作者：
Nieto, IP;Robledo, JPP;Sancho, LG
通讯作者：
Sancho, LG
影响因子：
2.4
作者：
Téllez-Zenteno, JF;Remes-Troche, JM;Garduño-Espinoza, J
通讯作者：
Garduño-Espinoza, J