Prognostic factors of thymectomy in patients with myasthenia gravis:: A cohort of 132 patients
Prognostic factors of thymectomy in patients with myasthenia gravis:: A cohort of 132 patients
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DOI：
10.1159/000050800
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发表时间：
2001-01-01
影响因子：
2.4
通讯作者：
Garduño-Espinoza, J
中科院分区：
文献类型：
--
作者：
Téllez-Zenteno, JF;Remes-Troche, JM;Garduño-Espinoza, J
目的：为了确定对胸腺切除术的反应和不良反应的相关因素，对132例明确诊断为重症肌无力的患者进行了巢式病例对照研究，这些患者在1987年至1997年期间接受了胸腺切除术，并随访了至少3年。方法：为了评估胸腺切除术的疗效，考虑以下两点：(a)患者在胸腺切除术前后服用吡哆斯的明及其他药物（类固醇、硫唑嘌呤）的剂量，(b)胸腺切除术前后的Osserman分级。将患者分为4组：(1)缓解期患者；(2)好转患者；(3)无变化的患者；(4)加重的患者。结果：疗效良好91例（69%），不良41例（31%）。各组疗效如下：50例患者缓解；41例好转；34例无变化，7例加重。60岁以上患者预后较差（比值比4.6,Cl 1.11 ~ 20.32, p 0.01）。病程超过3年的患者（优势比2.97,Cl 0.79 ~ 5.39, p 0.09）有不良预后倾向，但无统计学意义；病程超过4年的患者（优势比2.58,Cl 0.89 ~ 0.96, p 0.02）预后有统计学意义。从诊断到胸腺切除术病程超过3年的患者（优势比2.02,CI 0.69-5.90, p 0.15）和病程超过4年的患者（优势比2.53,Cl 0.83-7.7, p 0.06）预后较差，但差异无统计学意义。此外，患有Osserman I与预后不良有关。对比病理表现，胸腺瘤（比值比3.51,Cl 0.43-31.5, p 0.15）和胸腺萎缩（比值比2.19,Cl 0.93-5.16, p 0.04）预后较差。最后，胸腺切除术前使用类固醇（优势比2.26，比值比0.99-5.18,p 0.03）与较差的预后相关。结论：胸腺切除术有效率高（69%）。对预后最重要的变量是年龄和Osserman分期。预后不良的其他变量包括：术前使用大剂量吡哆斯的明和类固醇；疾病的总病程以及从诊断到手术之间的病程；既往胸腺切除术史；术后应用血浆置换，并在组织病理学结果中发现胸腺萎缩和胸腺瘤。版权所有(C) 2001 S. Karger AG，巴塞尔。
Objective: To identify the response to thymectomy and the factors associated with a poor response, a nested case-control study was performed on 132 patients with an established diagnosis of myasthenia gravis who had had a thymectomy between 1987 and 1997 and had been followed up for at least 3 years. Methods: In order to assess the response to thymectomy, the following two points were taken into account: (a) the dose of pyridostigmine and other drugs (steroids, azathioprine) that the patient took before and after thymectomy, and (b) the Osserman classification before and after thymectomy. The patients were divided into 4 groups: (1) patients in remission; (2) patients with improvement; (3) patients with no change, and (4) patients who were worse. Results: 91 patients had a good response (69%) and 41 patients had a poor response (31%). The response by groups was as follows: 50 patients were found to be in remission; 41 patients had improved; 34 patients had no changes, and 7 got worse. Being more than 60 years old was associated with a poor prognosis (odds ratio 4.6, Cl 1.11-20.32, p 0.01). The patients who had the disease for more than 3 years (odds ratio 2.97, Cl 0.79-5.39, p 0.09) had a tendency towards a bad prognosis even though there was no statistical significance, and for those who had it for more than 4 years (odds ratio 2.58, Cl 0.89-0.96, p 0.02) the bad prognosis was statistically significant. The patients who had the disease for more than 3 years between diagnosis and thymectomy (odds ratio 2.02, CI 0.69-5.90, p 0.15) and those with it for more than 4 years (odds ratio 2.53, Cl 0.83-7.7, p 0.06) had a tendency towards a poor prognosis even though there was no statistical significance. In addition, having Osserman I was associated with a bad prognosis. Referring to the pathological findings, patients with thymoma (odds ratio 3.51, Cl 0.43-31.5, p 0.15) and those with thymic atrophy (odds ratio 2.19, Cl 0.93-5.16, p 0.04) had a poor prognosis. Finally, the use of steroids before thymectomy (odds ratio 2.26, Cl 0.99-5.18, p 0.03) was associated with a worse prognosis. Conclusions: The response to thymectomy was high (69%). The variables that had the most prognostic importance were age and the Osserman stage. Other variables of poor prognosis were: high doses of pyridostigmine and use of steroids before surgery; the total duration of the disease and the duration of the disease between diagnosis and the surgical procedure; history of previous thymectomy; use of plasmapheresis after surgery, and the discovery of thymic atrophy and thymoma in the histopathological result. Copy right (C) 2001 S. Karger AG, Basel.