眼肌型重症肌无力患者免疫抑制治疗与病情泛化的关联：一项倾向评分分析。
Association of immunosuppression treatment with generalization among patients with ocular myasthenia gravis: A propensity score analysis.
作者信息
Ruan Zhe, Guo Rongjing, Zhou Hongyu, Gao Feng, Lin Ye, Xu Quan, Yu Liping, Wu Songdi, Lei Tao, Zhang Min, Gao Yanwu, Lu Xiaodan, Li Huanhuan, Sun Chao, Tang Baoli, Li Zhuyi, Chang Ting
机构信息
Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China.
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
出版信息
Eur J Neurol. 2022 Jun;29(6):1805-1814. doi: 10.1111/ene.15292. Epub 2022 Mar 7.
BACKGROUND
To analyze disease generalization in patients with ocular myasthenia gravis (OMG) treated with immunosuppression compared with patients without immunosuppression treatment.
METHODS
In this retrospective cohort study, we analyzed data from patients with OMG at seven medical centers in China from January 1, 2015 to May 1, 2019 and compared disease generalization in patients (treated with immunosuppression vs. not treated) within 2 years of disease onset using raw and inverse probability of treatment weighting (IPTW) analyses.
RESULTS
In the study population of 813 patients with OMG, 425 (52.3%) with immunosuppression had a mean (SD) onset age of 50.0 (15.1) years, and 188 (44.2%) were women. The remaining 388 (47.7%) patients were not immunosuppressed (mean age, 48.4 [15.0] years; 185 [47.7%] women). Disease generalization developed in 122 (31.4%) and 37 (8.7%) patients in the non-immunosuppression and immunosuppression groups, respectively. Relative to non-immunosuppression, immunosuppression was associated with a lower risk of generalization in a multivariable-adjusted Cox model (hazard ratio [HR] 0.27; 95% confidence interval [CI] 0.18-0.40; p < 0.001) and IPTW-weighted Cox model (HR 0.28; 95% CI 0.19-0.42; p < 0.001). In sensitivity analyses, longer duration of immunosuppression was associated with a lower risk of generalization (HR 0.90 for every 1-month increase; 95% CI 0.87-0.92; p < 0.001; IPTW-adjusted). Combination therapy with steroids and non-steroidal immunosuppressants showed superior efficacy in reducing the risk of generalization (HR 0.14; 95% CI 0.07-0.26; p < 0.001).
CONCLUSION
Immunosuppression significantly reduced the 2-year risk of generalization in patients with OMG.
背景
分析接受免疫抑制治疗的眼肌型重症肌无力（OMG）患者与未接受免疫抑制治疗的患者相比疾病的全身性表现。
方法
在这项回顾性队列研究中，我们分析了2015年1月1日至2019年5月1日期间中国七个医疗中心的OMG患者数据，并使用原始分析和治疗权重逆概率（IPTW）分析比较了疾病发病2年内患者（接受免疫抑制治疗与未接受治疗）的疾病全身性表现。
结果
在813例OMG患者的研究人群中，425例（52.3%）接受免疫抑制治疗的患者平均（标准差）发病年龄为50.0（15.1）岁，其中188例（44.2%）为女性。其余388例（47.7%）患者未接受免疫抑制治疗（平均年龄48.4 [15.0]岁；185例[47.7%]为女性）。非免疫抑制组和免疫抑制组分别有122例（31.4%）和37例（8.7%）患者出现疾病全身性表现。在多变量调整的Cox模型中（风险比[HR] 0.27；95%置信区间[CI] 0.18 - 0.40；p < 0.001）以及IPTW加权Cox模型中（HR 0.28；95% CI 0.19 - 0.42；p < 0.001），相对于未接受免疫抑制治疗，免疫抑制治疗与较低的全身性表现风险相关。在敏感性分析中，免疫抑制治疗时间越长，全身性表现风险越低（每增加1个月HR为0.90；95% CI 0.87 - 0.92；p < 0.001；IPTW调整）。类固醇与非类固醇免疫抑制剂联合治疗在降低全身性表现风险方面显示出更好的疗效（HR 0.14；95% CI 0.07 - 0.26；p < 0.001）。
结论
免疫抑制显著降低了OMG患者2年内出现全身性表现的风险。
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