Dias-Tosta E, Morato-Fernandes R N
Unidade de Neurologia do Hospital de Base do Distrito Federal.
Arq Neuropsiquiatr. 1989 Mar;47(1):39-50. doi: 10.1590/s0004-282x1989000100006.
This paper reviews a 12 year experience with myasthenia gravis management (surgical and drug therapy). A total of 27 patients were submitted to thymectomy, and 12 out of 13 showed fairly good results with this only form of therapy (15.3% with complete remission, 46.15% with marked improvement and 30.7% with moderate improvement). The other 14 need either a combination of surgery and plasmapheresis or corticosteroids with the cummulative results of: 14.8% of remission (4 out of 27), 74% of improvement (20 out of 27), 7.4% of worsening (2 out of 27) and 3.7% without change (1 out of 27). Two other patients not submitted to surgery showed either a stable state of their symptoms or a mildly worsening. Another eight patients not submitted to surgery could not be bollowed up. The authors also conclude by the validity of the use of plasmapheresis in myasthenic crises leading to a transient relief of the symptoms and suggest the use of corticosteroids as a second choice, due to their undesirable side effects and difficulty in their reduction and elimination without worsening the symptoms. Other immunosuppressive drugs could be used in cases in which those above cited therapies showed unsuitable results.
本文回顾了12年重症肌无力治疗（手术及药物治疗）的经验。共有27例患者接受了胸腺切除术，13例中的12例仅通过这种治疗方式就取得了相当不错的效果（完全缓解率为15.3%，显著改善率为46.15%，中度改善率为30.7%）。另外14例则需要手术与血浆置换或皮质类固醇联合治疗，累积结果为：缓解率14.8%（27例中的4例），改善率74%（27例中的20例），恶化率7.4%（27例中的2例），无变化率3.7%（27例中的1例）。另外2例未接受手术的患者症状要么稳定，要么稍有恶化。另外8例未接受手术的患者无法进行随访。作者还得出结论，血浆置换用于重症肌无力危象可有效导致症状暂时缓解，并建议将皮质类固醇作为第二选择，因为其存在不良副作用，且在不使症状恶化的情况下难以减少和消除。在上述治疗显示效果不佳的情况下，可使用其他免疫抑制药物。
