Clinical characteristics and predictive factors of myasthenic crisis after thymectomy
Clinical characteristics and predictive factors of myasthenic crisis after thymectomy
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DOI：
10.1016/j.jocn.2011.01.011
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发表时间：
2011-09-01
影响因子：
2
通讯作者：
Lee, Min-Cheol
中科院分区：
文献类型：
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作者：
Nam, Tai-Seung;Lee, Seung-Han;Lee, Min-Cheol
本研究的目的是评估胸腺切除术后肌无力危象（MCAT）的临床特征，并确定影响MCAT发生的预测因素。66例重症肌无力（MG）患者中，20例（30.3%）发生MCAT。从胸腺切除到MCAT的中位时间间隔为3.4个月。65.0%的患者在胸腺切除术的前6个月内发生MCAT，6个月后发生MCAT的患者为35.0%。9例（45.0%）首次MCAT后存活的患者发生了第二次MCAT，14例患者中有7例（50.0%）在胸腺切除术（MCBT）前有术前肌无力危象病史。MCBT病史和反映胸腺切除术围手术期临床严重程度的临床因素，包括术前Osserman分级、延髓症状、免疫抑制剂的使用、肺功能和术后延迟呼吸机撤机，在单变量分析中与MCAT的发生显著相关。然而，在多变量logistic回归分析中，MCBT病史是影响MCAT发生的唯一独立因素（比值比，17.9; 95%置信区间，4.019-79.873; p < 0.001）。因此，MCAT的发生可能仅与MCBT病史相关，而与反映围手术期临床严重程度的因素无关。有MCBT病史的MG患者更容易发生MCAT，特别是在胸腺切除术的前6个月内。(C)2011爱思唯尔有限公司保留所有权利。
The aims of this study were to assess the clinical characteristics of myasthenic crisis after thymectomy (MCAT) and to identify predictors affecting the occurrence of MCAT. Of 66 patients with myasthenia gravis (MG), MCAT occurred in 20 patients (30.3%). The median time interval from thymectomy to MCAT was 3.4 months. MCAT occurred in 65.0% of patients within the first 6 months of a thymectomy, and 35.0% after 6 months. A second MCAT occurred in nine (45.0%) patients who survived the first MCAT, and in seven (50.0%) of 14 patients with a history of a preoperative myasthenic crisis before thymectomy (MCBT). A history of MCBT, and clinical factors reflecting perioperative clinical severity at thymectomy, including preoperative Osserman's grade, bulbar symptoms, use of immunosuppressants, pulmonary function, and postoperative delayed ventilator weaning, were significantly correlated with the occurrence of MCAT on univariate analysis. However, a history of MCBT was the only independent factor affecting the occurrence of MCAT on multivariate logistic regression analysis (odds ratio, 17.9; 95% confidence interval, 4.019-79.873; p < 0.001). Thus, the occurrence of MCAT may be correlated only with a history of MCBT rather than with factors reflecting perioperative clinical severity. MG patients with a history of MCBT are more susceptible to MCAT, particularly within the first 6 months of thymectomy. (C) 2011 Elsevier Ltd. All rights reserved.