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重症肌无力胸腺切除术与保守药物治疗的综述分析

Review Analysis on Thymectomy vs Conservative Medical Management in Myasthenia Gravis.

作者信息

Rashid Muhammad Humayoun, Yasir Hafiz Khawaja Muhammad, Piracha Muhammad Usman, Salman Umer, Yousaf Hamza

机构信息

Neurology, Bakhtawar Amin Medical and Dental College, Multan, PAK.

Internal Medicine, Nishtar Medical University and Hospital, Multan, PAK.

出版信息

Cureus. 2020 Mar 26;12(3):e7425. doi: 10.7759/cureus.7425.

Abstract

Myasthenia gravis (MG) is an acquired, rare autoimmune disease that occurs due to autoantibodies blocking neuromuscular transmission. Its pathophysiology involves production of antibodies against the nicotinic acetylcholine receptors. Patients with negative anti-acetylcholine receptors (AChR) antibodies results are recognized as seronegative myasthenia gravis. In this review we tried to compare surgical and medical management of MG with each other to find out which is more effective. Different clinical trials and retrospective cohorts comparing these two parameters statistically were searched and studied. Remission rates in both medical and surgical management were compared. We found out that rates of remission were better in post thymectomy patients than patients on various medical treatment options including corticosteroids, immunosuppressants, intravenous immunoglobulins and acetylcholinesterase inhibitors alone. Hence thymectomy is studied to be the superior treatment option than other conservative medical management options alone.

摘要

重症肌无力(MG)是一种后天获得的罕见自身免疫性疾病,由自身抗体阻断神经肌肉传递引起。其病理生理学涉及针对烟碱型乙酰胆碱受体产生抗体。抗乙酰胆碱受体(AChR)抗体检测结果为阴性的患者被认定为血清阴性重症肌无力。在本综述中,我们试图比较重症肌无力的手术治疗和药物治疗,以找出哪种治疗方法更有效。我们检索并研究了对这两个参数进行统计学比较的不同临床试验和回顾性队列研究。比较了药物治疗和手术治疗的缓解率。我们发现,胸腺切除术后患者的缓解率高于仅接受包括皮质类固醇、免疫抑制剂、静脉注射免疫球蛋白和乙酰胆碱酯酶抑制剂在内的各种药物治疗的患者。因此,胸腺切除术被认为是比其他单纯保守药物治疗方案更优的治疗选择。

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本文引用的文献

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Randomized Trial of Thymectomy in Myasthenia Gravis.重症肌无力胸腺切除术的随机试验
N Engl J Med. 2016 Nov 17;375(20):2006-2007. doi: 10.1056/NEJMc1611704.
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J Autoimmun. 2014 Feb-Mar;48-49:143-8. doi: 10.1016/j.jaut.2014.01.003. Epub 2014 Feb 13.
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Myasthenia gravis: a review of available treatment approaches.重症肌无力:现有治疗方法综述
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