Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Ann Neurol. 2010 Dec;68(6):797-805. doi: 10.1002/ana.22139.
To compare clinical and economic outcomes following plasma exchange (PLEX) and intravenous immunoglobulin (IVIG) in U.S. patients with primary diagnoses of myasthenia gravis (MG).
Our cohort was identified from the Nationwide Inpatient Sample database for years 2000-2005 using codes from the International Classification of Diseases, 9th edition. Multivariate regression analyses were used to identify predictors of mortality, complications, length of stay, and total inpatient cost.
Among 1,606 hospitalized patients, the unadjusted mortality rate of MG crisis remained higher than those without crisis (0.44% vs 4.44%, p < 0.001), as well as the unadjusted complication rate (26.36% vs 11.23%, p < 0.001). MG crisis patients receiving PLEX had significantly more complications than those receiving IVIG (30.06% vs 14.79%, p < 0.001). Among the whole cohort, adjusted mortality and complication rates were not significantly different between the treatment groups (p > 0.05). Acute respiratory failure, major cardiac complications, and acute renal failure were associated with an increased mortality rate (p < 0.001). Age and respiratory failure were associated with an increased complication rate (p < 0.001). Length of stay was significantly longer for MG (6 vs 4 days, p < 0.001) and MG crisis (10 vs 5 days, p < 0.001) patients receiving PLEX. Inpatient costs were higher for MG ($26,662 vs $21,124, p < 0.01) and MG crisis ($53,801 vs $33,924, p < 0.001) patients receiving PLEX.
Compared to PLEX, IVIG appears of similar clinical (mortality and complications) and perhaps of superior economic (length of stay and total inpatient charges) outcomes in the treatment of MG. Elderly and those with complex comorbid diseases including acute respiratory failure may be better treated with IVIG.
比较美国原发性重症肌无力（MG）患者行血浆置换（PLEX）和静脉注射免疫球蛋白（IVIG）的临床和经济结局。
我们的队列是从 2000 年至 2005 年全国住院患者样本数据库中使用国际疾病分类第 9 版代码确定的。采用多变量回归分析来确定死亡率、并发症、住院时间和总住院费用的预测因素。
在 1606 例住院患者中，MG 危象患者的未调整死亡率高于非危象患者（0.44% vs 4.44%，p < 0.001），未调整并发症发生率也高于非危象患者（26.36% vs 11.23%，p < 0.001）。接受 PLEX 的 MG 危象患者的并发症发生率明显高于接受 IVIG 的患者（30.06% vs 14.79%，p < 0.001）。在整个队列中，两组间治疗的调整死亡率和并发症发生率无显著差异（p > 0.05）。急性呼吸衰竭、主要心脏并发症和急性肾功能衰竭与死亡率增加相关（p < 0.001）。年龄和呼吸衰竭与并发症发生率增加相关（p < 0.001）。MG（6 天 vs 4 天，p < 0.001）和 MG 危象（10 天 vs 5 天，p < 0.001）患者接受 PLEX 的住院时间显著延长。MG（26662 美元 vs 21124 美元，p < 0.01）和 MG 危象（53801 美元 vs 33924 美元，p < 0.001）患者接受 PLEX 的住院费用更高。
与 PLEX 相比，IVIG 在治疗 MG 方面的临床结局（死亡率和并发症）可能相似，而在经济结局（住院时间和总住院费用）方面可能更优。对于老年患者和合并急性呼吸衰竭等复杂合并症的患者，IVIG 可能是更好的治疗选择。
