Jiang Ping, Li Jie, Li Hong-Yan, Zhang Bin, Yue Yao-Xian, Wang Su-Yun, Zi Xi-Cun, Liu Shuang-Shuang, Li Yi-Fan, Jiao Li-Dong, Li Hai-Feng
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Neurology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Front Neurol. 2022 May 23;13:880045. doi: 10.3389/fneur.2022.880045. eCollection 2022.
Minimal manifestation (MM) or better was recommended as the treatment goal for myasthenia gravis (MG). The sustainability of this status has not been described quantitatively in patients who had attained or are close to it.
Patients who were with no or slight impact on daily living were recruited and followed at baseline and 3, 6, and 12 months. The included patients were classified into 3 post-intervention status (PIS) categories: remission (R), MM, and slight impact (SI). The proportion of patients belonging to real-time (not considering the intervals between assessments) and sustained (considering the intervals between assessments) PIS categories was compared at each follow-up. A sensitivity analysis (SA) cohort was established by including patients with PIS categories in all four follow-ups. The QMGS, MG-ADL, and MG-QOL15 scores in patients belonging to each PIS category at each follow-up were compared. The sustainability of the R/MM status was examined and correlated with real-time R/MM status at follow-ups.
At baseline, 376 patients could be classified, including 55 as R (14.2%), 209 as MM (54.0%), and 112 as SI (28.9%). In the whole cohort, 68.8-89.7%, 71-76.7% and 19.8-77.1% of the patients classified into real-time R, MM, and SI categories remained unchanged in each follow-up compared with the previous follow-up. The proportion of patients belonging to each real-time or sustained R/MM status at the three follow-ups was 89.7-92.1 or 60.8-67. In the SA cohort, at least 86.4% of the baseline R/MM patients remained in R/MM status till 12 months. There were no differences in keeping real-time R/MM status at 6 or 12 months between patients with and without sustained R/MM status at 3 and 6 months. There were differences in the QMGS, MG-ADL, and MG-QOL15 scores among patients belonging to each real-time category at baseline and follow-ups, ranking as R < MM < SI. The same trend was observed in patients belonging to each sustained PIS category with smaller scores than the same items of real-time categories.
The sustainability of the R/MM status was confirmed. The R/MM status indicated a stable state of MG. The QMGS, MG-ADL, and MG-QOL15 scores may provide a quantitative reference for these PIS.
推荐将最小表现（MM）或更佳状态作为重症肌无力（MG）的治疗目标。对于已达到或接近该状态的患者，尚未对这种状态的可持续性进行定量描述。
招募对日常生活无影响或影响轻微的患者，并在基线以及3、6和12个月时进行随访。纳入的患者被分为3种干预后状态（PIS）类别：缓解（R）、MM和轻微影响（SI）。比较每次随访时属于实时（不考虑评估间隔）和持续（考虑评估间隔）PIS类别的患者比例。通过纳入在所有四次随访中具有PIS类别的患者建立一个敏感性分析（SA）队列。比较每次随访时属于每个PIS类别的患者的QMGS、MG-ADL和MG-QOL15评分。检查R/MM状态的可持续性，并将其与随访时的实时R/MM状态相关联。
在基线时，376例患者可被分类，其中55例为R（14.2%），209例为MM（54.0%），112例为SI（28.9%）。在整个队列中，与上一次随访相比，分类为实时R、MM和SI类别的患者在每次随访中有68.8 - 89.7%、71 - 76.7%和19.8 - 77.1%保持不变。在三次随访中，属于每个实时或持续R/MM状态的患者比例为89.7 - 92.1%或60.8 - 67%。在SA队列中，至少86.4%的基线R/MM患者直到12个月时仍保持R/MM状态。在3个月和6个月时具有或不具有持续R/MM状态的患者在6个月或12个月时保持实时R/MM状态方面没有差异。在基线和随访时，属于每个实时类别的患者的QMGS、MG-ADL和MG-QOL15评分存在差异，排序为R < MM < SI。在属于每个持续PIS类别的患者中也观察到相同趋势，其评分低于实时类别的相同项目。
证实了R/MM状态的可持续性。R/MM状态表明MG处于稳定状态。QMGS、MG-ADL和MG-QOL15评分可为这些PIS提供定量参考。
