Predictive score for oral corticosteroid-induced initial worsening of seropositive generalized myasthenia gravis
Predictive score for oral corticosteroid-induced initial worsening of seropositive generalized myasthenia gravis
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DOI：
10.1016/j.jns.2018.10.018
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发表时间：
2019-01-15
影响因子：
4.4
通讯作者：
Kuwabara, Satoshi
中科院分区：
文献类型：
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作者：
Kanai, Tetsuya;Uzawa, Akiyuki;Kuwabara, Satoshi
工作背景：在重症肌无力（MG）的治疗中，皮质类固醇给药开始后最初的症状恶化是一个主要问题。然而，与此问题相关的风险因素或特定患者背景尚未完全了解。我们的目的是确定的危险因素，并制定了一个评分系统，用于预测初始恶化的泛发性MG。方法：我们招募了62例泛发性MG患者的抗乙酰胆碱受体抗体。初始恶化定义为开始类固醇治疗后2周内定量MG评分增加3分。采用多变量logistic回归模型确定危险因素，并分配预测评分。Bootstrap rescue被应用于评估风险评分模型的内部validity.Results：类固醇诱导的初始恶化发生在26%的MG患者，并与胸腺瘤相关或早发MG（p = 0.018），初始泼尼松龙剂量>= 40 mg/天（p = 0.029），上肢无力（p = 0.039）。逐步多元逻辑回归确定了这三个临床因素预测初始恶化的MG。0-3分的预测评分具有0.770（0.625-0.878）的自举曲线下面积。结论：我们的评分系统基于三个临床特征可以预测激素诱导的MG初始恶化的可能性。
Background: Initial worsening of symptoms after the start of corticosteroid administration is a major concern in the treatment of myasthenia gravis (MG). However, the risk factors or specific patient backgrounds related to this issue have not been fully understood. We aimed to determine the risk factors and developed a scoring system for predicting initial worsening in generalized MG.Methods: We enrolled 62 generalized MG patients with anti-acetylcholine receptor antibody. Initial worsening was defined as an increment of three points in the Quantitative MG score within 2 weeks after the start of steroid treatment. A multivariate logistic regression model was used to determine the risk factors, and predictive scores were assigned. Bootstrap resampling was applied to evaluate the risk score model's internal validity.Results: Steroid-induced initial worsening occurred in 26% of MG patients and was correlated with thymoma-associated or early-onset MG (p = 0.018), initial prednisolone doses >= 40 mg/day (p = 0.029), and upper limb weakness (p = 0.039). Stepwise multivariate logistic regression identified these three clinical factors for predicting initial worsening in MG. A predictive score of 0-3 points had a bootstrapping area under the curve of 0.770 (0.625-0.878).Conclusions: Our scoring system based on three clinical characteristics can predict the likelihood of steroid induced initial worsening in MG.