Liu Wei, Liu Guojin, Fan Zhimin, Gai Xueliang
Department of Thoracic Surgery, First Hospital, Jilin University, Changchun, China.
Chin Med J (Engl). 2003 Oct;116(10):1578-81.
To determine whether the clinical and pathologic characteristics and prognoses of myasthenia gravis (MG) patients below 15 years differ from those patients over 50 years after thymectomy.
We reviewed the registry material of 30 pediatric and 32 elderly MG patients after thymectomy, including their age, sex, clinical classification, pathological types, and prognoses. The Chi-square test or Wilcoxon's rank-sum test was used to determine the statistical differences between the children and elderly groups.
No significant difference was seen in sex distribution between the two groups. (Chi-square test, P=0.625), but there were differences in clinical classification: more type I was observed in the pediatric group than in the elderly group, but more type II or III was seen in the elderly group (Wilcoxon's rank-sum test, P<0.001). As to pathological types, the pediatric group was also significantly different from the elderly group (Chi-square test, P<0.01). All of the patients (100%) in the pediatric group had thymus hyperplasia, but in the elderly group more than half (56.26%) were found to have thymoma (benign or malignant). The prognoses after thymectomy were better in the pediatric group than in the elderly group (Wilcoxon's rank-sum test, P<0.001).
Because the prognoses are generally better than those of the elderly patients, we should be careful when operating on pediatric patients of ocular type. The elderly patients tend to receive more aggressive treatment because of more severe generalized types often associated with thymoma and poor prognoses. Both pediatric and elderly patients are seldom associated with other autoimmune disease.
确定15岁以下重症肌无力（MG）患者与50岁以上患者胸腺切除术后的临床病理特征及预后是否存在差异。
我们回顾了30例儿科MG患者和32例老年MG患者胸腺切除术后的登记资料，包括他们的年龄、性别、临床分类、病理类型及预后。采用卡方检验或Wilcoxon秩和检验来确定儿童组和老年组之间的统计学差异。
两组间性别分布无显著差异（卡方检验，P = 0.625），但临床分类存在差异：儿科组I型患者比老年组多，而老年组II型或III型患者更多（Wilcoxon秩和检验，P < 0.001）。在病理类型方面，儿科组与老年组也有显著差异（卡方检验，P < 0.01）。儿科组所有患者（100%）均有胸腺增生，而老年组超过一半（56.26%）被发现患有胸腺瘤（良性或恶性）。胸腺切除术后儿科组的预后比老年组好（Wilcoxon秩和检验，P < 0.001）。
由于儿科患者的预后总体上优于老年患者，因此对眼肌型儿科患者进行手术时应谨慎。老年患者往往因更严重的全身型疾病（常与胸腺瘤相关且预后较差）而接受更积极的治疗。儿科和老年患者很少与其他自身免疫性疾病相关。
