Dohi-Iijima Naoko, Sekijima Yoshiki, Nakamura Akinori, Morita Hiroshi, Matsuda Masayuki, Haniuda Masayuki, Hashimoto Takao, Ikeda Shu-ichi
Third Department of Medicine, Shinshu University School of Medicine, Matsumoto.
Intern Med. 2004 Mar;43(3):189-93. doi: 10.2169/internalmedicine.43.189.
Thymectomy has become recognized as an integral element in the treatment of patients with myasthenia gravis (MG). Although the incidence of elderly-onset MG has recently been increasing, there is little data demonstrating the efficacy and complications of thymectomy in this population. To clarify this point, we divided the thymectomized patients with MG into young and elderly groups, and retrospectively examined their clinical features and therapeutic outcomes.
We reviewed 57 MG patients who had been admitted to our hospital between 1988 and 2002. The patients were classified into young (younger than 60) and elderly (60 or older) groups according to the age of onset, and the therapeutic outcomes of thymectomy were evaluated using myasthenic severity scales and the duration from operation to discharge.
Myasthenic severity scales significantly improved after thymectomy in the elderly group both with (p<0.005) and without thymoma (p<0.05) compared with before. With regard to the duration from thymectomy to discharge, no significant difference could be found between the young and elderly groups, irrespective of associated thymoma. There were no serious complications during and after thymectomy in either the young or the elderly group.
Despite various possible complications due to aging, thymectomy should be actively considered also in the treatment of elderly MG patients because it can reliably and safely improve myasthenic symptoms in combination with immunosuppressive agents, including corticosteroid.
胸腺切除术已成为重症肌无力（MG）患者治疗中不可或缺的一部分。尽管近年来老年起病型MG的发病率在上升，但几乎没有数据表明胸腺切除术在该人群中的疗效和并发症情况。为阐明这一点，我们将接受胸腺切除术的MG患者分为青年组和老年组，并回顾性研究了他们的临床特征和治疗结果。
我们回顾了1988年至2002年间我院收治的57例MG患者。根据发病年龄将患者分为青年组（年龄小于60岁）和老年组（年龄60岁及以上），并使用重症肌无力严重程度量表以及从手术到出院的时长来评估胸腺切除术的治疗效果。
与术前相比，老年组无论有无胸腺瘤，胸腺切除术后重症肌无力严重程度量表均显著改善（有胸腺瘤者p<0.005，无胸腺瘤者p<0.05）。关于胸腺切除术后至出院的时长，无论有无胸腺瘤，青年组和老年组之间均未发现显著差异。青年组和老年组在胸腺切除术中及术后均未出现严重并发症。
尽管衰老可能导致各种并发症，但胸腺切除术仍应积极应用于老年MG患者的治疗，因为它能与包括皮质类固醇在内的免疫抑制剂联合使用，可靠且安全地改善重症肌无力症状。
