Does perioperative high-dose prednisolone have clinical benefits for generalized myasthenia gravis?
Does perioperative high-dose prednisolone have clinical benefits for generalized myasthenia gravis?
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DOI：
10.1016/j.ejcts.2006.03.022
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发表时间：
2006-06-01
影响因子：
3.4
通讯作者：
Fujisawa, Takehiko
中科院分区：
文献类型：
--
作者：
Sekine, Yasuo;Kawaguchi, Naoki;Fujisawa, Takehiko
目的：本研究的目的是阐明围手术期给予大剂量泼尼松龙（PSL）联合扩大胸腺切除术对连续 116 例全身性重症肌无力（MG）患者的近期结局的临床益处。方法：对 116 例诊断为全身性 MG 的患者进行回顾性分析，这些患者接受隔日口服大剂量 PSL（100 mg/隔天）并接受经胸骨扩大胸腺切除术。评估术后肌无力危象的发生率、类固醇的不良反应、长期结果，如完全稳定缓解（CSR）、药物缓解（PR）或改善（Imp）以及CSR后疾病复发。结果：6 名患者（5.2%）经历了胸腺切除术后肌无力危象。粗累计CSR率和PR+CSR率分别为44.8%和62.7%。生命表分析显示，3年、5年和10年时分别有41.8%、52.8%和63.4%的患者处于CSR状态。多变量分析显示，根据美国重症肌无力基金会 (MGFA) 标准的年龄和治疗前分类往往是 CSR 的独立预测因素。椎体受压者占6.9%。骨折，13.8% 患有白内障，5.2% 患有类固醇诱发的糖尿病。生命表分析显示，CSR 后 3 年和 5 年的复发率分别为 36.8% 和 46.0%。胸腺瘤患者的复发率显着高于非胸腺瘤患者（p = 0.001）。结论：隔日给予大剂量泼尼松龙可降低胸腺切除术后肌无力危象的风险。胸腺瘤的存在是 CSR 后 MG 复发的危险因素。 (c) 2006 Elsevier B.V. 保留所有权利。
Objective: The purpose of this study was to clarify the clinical benefits of perioperative administration of high-dose prednisolone (PSL) combined with extended thymectomy on the tong-term outcomes of 116 consecutive patients with generalized myasthenia gravis (MG). Methods: A retrospective review was conducted on 116 patients diagnosed with generalized MG who received alternate-day oral administration of high-dose PSL (100 mg/alternate days) and had undergone transsternal extended thymectomy. Incidences of postoperative myasthenic crisis, adverse effects of steroid, long-term outcomes, such as complete stable remission (CSR), pharmacologic remission (PR) or improvement (Imp), and disease recurrence after CSR were evaluated. Results: Six patients (5.2%) experienced post-thymectomy myasthenic crisis. Crude cumulative CSR and PR + CSR rates were 44.8 and 62.7%, respectively. Life table analysis showed that 41.8, 52.8 and 63.4% of the patients were in CSR at 3, 5 and 10 years, respectively. Multivariate analysis revealed that age and pretreatment classification according to the Myasthenia Gravis Foundation of America (MGFA) criteria tended to be independent predictors of CSR. There were 6.9% with compressive vertebral. fracture, 13.8% with cataract, and 5.2% with steroid-induced diabetes. Life table analysis revealed that recurrence rates after CSR were 36.8 and 46.0% at 3 and 5 years, respectively. Patients with thymoma had a significantly higher rate of recurrence than those without thymoma (p = 0.001). Conclusions: Alternate-day administration of high-dose prednisolone reduced the risk of post-thymectomy myasthenic crisis. Presence of thymoma was a risk factor for MG recurrence after CSR. (c) 2006 Elsevier B.V. All rights reserved.