Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea.
J Neurol. 2019 Apr;266(4):960-968. doi: 10.1007/s00415-019-09222-2. Epub 2019 Feb 6.
Whether thymectomy is beneficial in elderly patients with myasthenia gravis (MG) is unclear. Thus, we assessed whether conducting thymectomy in MG patients aged ≥ 50 years is beneficial. This retrospective cohort study included patients with MG between 1990 and 2018. Thymectomy and control cohorts were selected from among the population of MG patients with an age at onset of ≥ 45 years and elevated concentrations of acetylcholine-receptor antibodies. Patients with evidence of thymic malignancy were excluded. Of these patients, those who underwent thymectomy at the age of ≥ 50 years were designated as the thymectomy group and those who received only medical treatment were designated as the medical treatment group. We compared the Myasthenia Gravis Foundation of America post-intervention status between the thymectomy and medical treatment groups. Landmark analysis was conducted with the landmark set at 24 months. A total of 34 and 105 patients were classified into the thymectomy and medical treatment groups, respectively. Before landmark analysis, the thymectomy group had a higher cumulative incidence of pharmacologic remission (p = 0.009) and complete stable remission (p = 0.022) than the medical treatment group. After landmark analysis, the thymectomy group had a 2.22-fold (95% confidence interval 1.01-4.80) increased chance of achieving pharmacologic remission compared to the medical treatment group after adjustment for age, sex, and disease severity. No significant difference was observed in the rate of relapse after pharmacological remission between the thymectomy (16.7%) and medical treatment groups (21.4%). In conclusion, thymectomy may have a beneficial effect in elderly patients with non-thymomatous generalized MG.
胸腺切除术是否对老年重症肌无力（MG）患者有益尚不清楚。因此，我们评估了对年龄≥50 岁的 MG 患者行胸腺切除术是否有益。这项回顾性队列研究纳入了 1990 年至 2018 年间的 MG 患者。胸腺切除术组和对照组均选自发病年龄≥45 岁且乙酰胆碱受体抗体浓度升高的 MG 患者人群。排除有胸腺癌证据的患者。在这些患者中，将 50 岁及以上行胸腺切除术的患者指定为胸腺切除术组，仅接受药物治疗的患者指定为药物治疗组。我们比较了胸腺切除术组和药物治疗组的重症肌无力基金会美国干预后状态。采用 24 个月的标志分析。共有 34 名和 105 名患者分别归入胸腺切除术组和药物治疗组。在标志分析之前，胸腺切除术组获得药物缓解的累积发生率（p=0.009）和完全稳定缓解的累积发生率（p=0.022）均高于药物治疗组。标志分析后，校正年龄、性别和疾病严重程度后，胸腺切除术组达到药物缓解的几率是药物治疗组的 2.22 倍（95%置信区间为 1.01-4.80）。药物缓解后复发率在胸腺切除术组（16.7%）和药物治疗组（21.4%）之间无显著差异。总之，胸腺切除术可能对非胸腺瘤型全身性 MG 老年患者有益。
