胸腺切除术对无胸腺瘤的迟发性重症肌无力的影响。

Effects of thymectomy on late-onset myasthenia gravis without thymoma.

作者信息

Kawaguchi Naoki, Kuwabara Satoshi, Nemoto Yuko, Fukutake Toshio, Arimura Kimiyoshi, Osame Mitsuhiro, Hattori Takamichi

机构信息

Department of Neurology, Chiba University, Graduate School of Medicine, 1-8-1 Inohna, Chuo-ku, Chiba 260-8670, Japan.

出版信息

Clin Neurol Neurosurg. 2007 Dec;109(10):858-61. doi: 10.1016/j.clineuro.2007.08.006. Epub 2007 Sep 27.

DOI:10.1016/j.clineuro.2007.08.006

PMID:17904281

Abstract

OBJECTIVES

This study aims to investigate whether thymectomy is beneficial for late-onset (>50 years) myasthenia gravis patients with no thymoma, particularly for those with mild generalized weakness.

PATIENTS AND METHODS

A total of 34 patients were included in the study. The clinical course and long-term outcomes over 2 years were reviewed in 20 patients who underwent thymectomy and in 14 without thymectomy.

RESULTS

Of the 34 patients, 20 (59%) underwent thymectomy. Thymectomized patients had more severe disability at entry than non-thymectomized patients, but outcome measures did not significantly differ between the two patient groups. Moreover, subgroup analyses including 22 patients with mild generalized weakness at entry showed that the thymectomized group (n=10) showed a greater percentage of clinical remission (no symptoms; 50% versus 17%; p=0.11) and a lower frequency of the presence of generalized symptoms (30% versus 75%; p<0.05) than the non-thymectomized group (n=12) at the end of follow-up (means 9.6 years after onset).

CONCLUSIONS

Thymectomy is a potentially effective treatment for late onset, non-thymomatous patients with mild generalized myasthenia gravis.

摘要

目的

本研究旨在调查胸腺切除术对无胸腺瘤的晚发型（>50岁）重症肌无力患者是否有益，特别是对那些有轻度全身无力症状的患者。

患者与方法

共有34例患者纳入本研究。对20例行胸腺切除术的患者和14例未行胸腺切除术的患者的临床病程及2年以上的长期预后进行了回顾。

结果

34例患者中，20例（59%）接受了胸腺切除术。接受胸腺切除术的患者在入组时的残疾程度比未接受胸腺切除术的患者更严重，但两组患者的预后指标无显著差异。此外，对入组时22例有轻度全身无力症状的患者进行亚组分析显示，在随访结束时（发病后平均9.6年），接受胸腺切除术的组（n = 10）临床缓解率（无症状；50%对17%；p = 0.11）更高，全身症状出现频率更低（30%对75%；p<0.05），与未接受胸腺切除术的组（n = 12）相比。