Men Li-na, Liu Wei-bin, Chen Zhen-guang, He Xue-tao, Zhang Ying, Huang Ruxun
Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Yi Xue Za Zhi. 2008 Jun 3;88(21):1446-9.
To identify the recurrence-related factors in patients with myasthenia gravis (MG) after extended thymectomy.
Followed up was conducted on 271 MG patients, 127 males and 146 females, aged 31 (4-57), who underwent extended thymectomy for 18-84 months. Post-operational pathological examination showed 32 cases of thymoma and 239 cases of diseases other than thymoma. After operation the patients were treated with pyridostigmine only or combined with adrenocortical hormone. The relevant factors of the 135 patients with relapse were evaluated: sex, Osserman classification, age while being operated on, duration of preoperative period, pathologic type of thymus, use of steroid before operation, infection after operation, whether only taking anticholinesterase drugs after operation, use of steroid immediately after operation, stopping medicine or decreasing the dose of medicine within 1-3 months after remission of symptoms.
COX univariate analysis revealed that failure to take steroid immediately after operation (OR = 2.914, P = 0.000), infection after operation (OR = 3.441, P = 0.000), only taking anticholinesterase drugs after operation (OR = 5.947, P = 0.000), and immediately stopping medicine use or decreasing the dose of medicine within 1-3 months after the remission of symptoms (OR = 2.242, P = 0.000) were prognostic factors for postoperative recurrence. On the other hand, multivariate logistic regression analysis revealed that infection after operation (OR = 47.63, P = 0.000), only taking anticholinesterase drugs after operation (OR = 62.38, P = 0.000), and stopping medicine or decreasing the dose of medicine 1-3 months after remission of symptoms (OR = 32.76, P = 0.000) were independent influencing factors of recurrence after operation.
Post-operative infection, only taking pyridostigmine, and stopping medicine too early are independent factors of postoperative relapse. Regular treatment and timely use of adrenocortical hormone decrease the recurrence after operation.
确定扩大胸腺切除术后重症肌无力（MG）患者的复发相关因素。
对271例MG患者进行随访，其中男性127例，女性146例，年龄31岁（4 - 57岁），接受扩大胸腺切除术18 - 84个月。术后病理检查显示胸腺瘤32例，非胸腺瘤疾病239例。术后患者仅用吡啶斯的明治疗或联合肾上腺皮质激素治疗。对135例复发患者的相关因素进行评估：性别、Osserman分型、手术时年龄、术前病程、胸腺病理类型、术前是否使用类固醇、术后感染、术后是否仅服用抗胆碱酯酶药物、术后是否立即使用类固醇、症状缓解后1 - 3个月内是否停药或减药。
COX单因素分析显示，术后未立即使用类固醇（OR = 2.914，P = 0.000）、术后感染（OR = 3.441，P = 0.000）、术后仅服用抗胆碱酯酶药物（OR = 5.947，P = 0.000）以及症状缓解后1 - 3个月内立即停药或减药（OR = 2.242，P = 0.000）是术后复发的预后因素。另一方面，多因素logistic回归分析显示，术后感染（OR = 47.63，P = 0.000）、术后仅服用抗胆碱酯酶药物（OR = 62.38，P = 0.000）以及症状缓解后1 - 3个月内停药或减药（OR = 32.76，P = 0.000）是术后复发的独立影响因素。
术后感染、仅服用吡啶斯的明以及过早停药是术后复发的独立因素。规范治疗并及时使用肾上腺皮质激素可降低术后复发率。
