Nguyen Minh, Clough Meaghan, Cruse Belinda, van der Walt Anneke, Fielding Joanne, White Owen B
Department of Neuroscience (MN, MC, AW, JF, OBW), Monash Health; Department of Neurology (BC), Royal Melbourne Hospital; and Department of Neurology (MN, AW), Alfred Health, Melbourne, Australia.
Neurol Clin Pract. 2024 Feb;14(1):e200244. doi: 10.1212/CPJ.0000000000200244. Epub 2024 Jan 4.
Myasthenia gravis (MG) is a condition with significant phenotypic variability, posing a diagnostic challenge to many clinicians worldwide. Prolonged diagnosis can lead to reduced remission rates and morbidity. This study aimed to identify factors leading to a longer time to diagnosis in MG that could be addressed in future to optimize diagnosis time.
One hundred and ten patients from 3 institutions in Melbourne, Australia, were included in this retrospective cohort study. Demographic and clinical data were collected for these patients over the first 5 years from diagnosis and at 10 years. Nonparametric statistical analysis was used to identify factors contributing to a longer diagnosis time.
The median time for MG diagnosis was 102 (345) days. 90% of patients were diagnosed before 1 year. Female patients took longer than male patients to be diagnosed ( = 0.013). The time taken for first presentation after symptom onset contributed most to diagnosis time (median 17 [141] days), with female patients and not working as contributory factors. Neurology referral took longer if patients had diplopia ( = 0.022), respiratory ( = 0.026) symptoms, or saw an ophthalmologist first ( < 0.001). Outpatient management compared with inpatient was associated with a longer time to be seen by a neurologist from referral ( < 0.001), for the first diagnostic result to return ( = 0.001), and for the result to be reviewed ( < 0.001). Ocular MG had a median greater time to neurologist review than generalized MG (median 5 [25] days vs 1 [13] days, = 0.035). Electrophysiology tests took longer for outpatients than inpatients (median 21 [35] days vs 2 [8] days, < 0.001). Outpatients were also started on treatment later than inpatients ( < 0.001). There was no association of MG severity, ethnicity, age, medical and ocular comorbidities, and public or private health service on diagnosis time. There was also no impact of time to diagnosis on Myasthenia Gravis Foundation of America outcomes, number of follow-ups or hospitalizations, or prevalence of treatments used. This study is limited by low patient numbers and its retrospective nature.
This study identified several factors that can contribute to a prolonged diagnosis time of MG. Patient and clinician education about MG and outpatient diagnostic efficiency needs emphasis. Further studies are also needed to explore the delayed presentation time of women and nonworking patients in MG.
重症肌无力（MG）具有显著的表型变异性，给全球许多临床医生带来了诊断挑战。诊断时间延长会导致缓解率降低和发病率增加。本研究旨在确定导致MG诊断时间延长的因素，以便未来加以解决，从而优化诊断时间。
本回顾性队列研究纳入了来自澳大利亚墨尔本3家机构的110例患者。收集了这些患者从诊断开始的前5年及10年的人口统计学和临床数据。采用非参数统计分析来确定导致诊断时间延长的因素。
MG诊断的中位时间为102（345）天。90%的患者在1年内被诊断。女性患者的诊断时间比男性患者长（P = 0.013）。症状出现后首次就诊的时间对诊断时间贡献最大（中位时间为17[141]天），女性患者和未工作是促成因素。如果患者有复视（P = 0.022）、呼吸系统症状（P = 0.026）或首先看眼科医生（P < 0.001），转介至神经科的时间会更长。与住院治疗相比，门诊管理与从转介到神经科医生就诊的时间更长相关（P < 0.001），与首次诊断结果返回的时间相关（P = 0.001），与结果被复查的时间相关（P < 0.001）。眼肌型MG患者至神经科医生复查的中位时间比全身型MG更长（中位时间为5[25]天对1[13]天，P = 0.035）。门诊患者的电生理检查时间比住院患者长（中位时间为21[35]天对2[8]天，P < 0.001）。门诊患者开始治疗的时间也比住院患者晚（P < 0.001）。MG的严重程度、种族、年龄、内科和眼科合并症以及公立或私立医疗服务与诊断时间无关。诊断时间对美国重症肌无力基金会的结局、随访或住院次数或所用治疗方法的患病率也没有影响。本研究因患者数量少及其回顾性性质而受到限制。
本研究确定了几个可能导致MG诊断时间延长的因素。需要强调对患者和临床医生进行关于MG及门诊诊断效率的教育。还需要进一步研究来探讨MG中女性患者和未工作患者就诊延迟的时间。
