Durelli L, Maggi G, Casadio C, Ferri R, Rendine S, Bergamini L
Clinica Neurologica, Faculty of Medicine, University of Turin, Italy.
J Neurol Neurosurg Psychiatry. 1991 May;54(5):406-11. doi: 10.1136/jnnp.54.5.406.
The role of thymectomy in the treatment of myasthenia gravis (MG) was analysed in 400 patients affected with generalised MG operated on between 1974-83, and prospectively followed up for five years after surgery. The occurrence of stable remission (SR) (that is, complete clinical drug-free remission that remains stable for all the subsequent follow up) was the endpoint of survival analyses and the distribution of SR time (SRT, that is, the interval from thymectomy to the occurrence of SR) was assessed by actuarial and Cox multivariate analyses. SRT distribution after surgery showed a slow progressive increase of cumulative SR rate that could both be ascribed to a delayed effect of thymectomy as well as reflect the natural history of MG, itself characterised by an increasing probability of spontaneous remission with time. SRT distribution was similar after stratification for all variables studied except when patients without thymoma were stratified for the need for immunosuppressive treatment in addition to thymectomy. Patients without thymoma who did not require additional immunosuppressive therapy (n = 130) had the highest SR rate occurring in the two years after thymectomy, and differed from patients treated with immunosuppressive drugs who showed the highest SR rate five years after surgery. Actuarial analysis has therefore identified a subgroup of patients where SR, occurring in the first years after surgery, is more likely to be ascribed to thymectomy than merely reflect the natural course of the disease.
对1974年至1983年间接受手术治疗的400例全身型重症肌无力（MG）患者进行分析，探讨胸腺切除术在MG治疗中的作用，并在术后进行了为期五年的前瞻性随访。生存分析的终点是稳定缓解（SR）的发生（即完全临床药物缓解且在所有后续随访中保持稳定），并通过精算分析和Cox多变量分析评估SR时间（SRT，即从胸腺切除术到SR发生的间隔时间）的分布。术后SRT分布显示累积SR率缓慢渐进增加，这既可以归因于胸腺切除术的延迟效应，也反映了MG的自然病程，其本身的特点是随着时间推移自发缓解的概率增加。除了对无胸腺瘤患者根据胸腺切除术后是否需要免疫抑制治疗进行分层外，对所有研究变量进行分层后，SRT分布相似。不需要额外免疫抑制治疗的无胸腺瘤患者（n = 130）在胸腺切除术后两年内SR率最高，与接受免疫抑制药物治疗的患者不同，后者在术后五年SR率最高。因此，精算分析确定了一个患者亚组，其中术后头几年出现的SR更可能归因于胸腺切除术，而不仅仅是反映疾病的自然病程。
