Sun Chao, Ruan Zhe, Zhang Yu, Guo Rongjing, Li Huanhuan, Wang Tantan, Gao Ting, Tang Yonglan, Song Na, Hao Sijia, Huang Xiaoxi, Li Shuang, Ning Fan, Su Yue, Lu Qiang, Wang Qingqing, Cao Xiangqi, Li Zhuyi, Chang Ting
Department of Neurology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China.
Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China.
Front Neurol. 2024 Jan 12;14:1336823. doi: 10.3389/fneur.2023.1336823. eCollection 2023.
Thymectomy is an efficient and standard treatment strategy for patients with myasthenia gravis (MG), postoperative myasthenic crisis (POMC) is the major complication related to thymectomy and has a strongly life-threatening effect. As a biomarker, whether the bilirubin level is a risk factor for MG progression remains unclear. This study aimed to investigate the association between the preoperative bilirubin level and postoperative myasthenic crisis (POMC).
We analyzed 375 patients with MG who underwent thymectomy at Tangdu Hospital between January 2012 and September 2021. The primary outcome measurement was POMC. The association between POMC and bilirubin level was analyzed by restricted cubic spline (RCS). Indirect bilirubin (IBIL) was divided into two subgroups based on the normal upper limit of IBIL, 14 μmol/L.
Compared with non-POMC group, IBIL levels were significantly higher in patients with POMC. Elevated IBIL levels were closely associated with an increased risk of POMC ( for trend = 0.002). There was a dose-response curve relationship between IBIL levels and POMC incidence ( for non-linearity = 0.93). However, DBIL levels showed a U-shaped association with POMC incidence. High IBIL level (≥14 μmol/L) was an independent predictive factor for POMC [odds ratio = 3.47, 95% confidence interval (CI): 1.56-7.8, = 0.002]. The addition of high IBIL levels improved the prediction model performance (net reclassification index = 0.186, 95% CI: 0.039-0.334; integrated discrimination improvement = 0.0345, 95% CI: 0.005-0.065).
High preoperative IBIL levels, especially those exceeding the normal upper limit, could independently predict the incidence of POMC.
胸腺切除术是重症肌无力（MG）患者一种有效且标准的治疗策略，术后肌无力危象（POMC）是与胸腺切除术相关的主要并发症，具有严重的危及生命的影响。作为一种生物标志物，胆红素水平是否为MG病情进展的危险因素仍不明确。本研究旨在探讨术前胆红素水平与术后肌无力危象（POMC）之间的关联。
我们分析了2012年1月至2021年9月期间在唐都医院接受胸腺切除术的375例MG患者。主要结局指标是POMC。采用限制性立方样条（RCS）分析POMC与胆红素水平之间的关联。间接胆红素（IBIL）根据IBIL正常上限14 μmol/L分为两个亚组。
与非POMC组相比，POMC患者的IBIL水平显著更高。IBIL水平升高与POMC风险增加密切相关（趋势P = 0.002）。IBIL水平与POMC发生率之间存在剂量反应曲线关系（非线性P = 0.93）。然而，直接胆红素（DBIL）水平与POMC发生率呈U形关联。高IBIL水平（≥14 μmol/L）是POMC的独立预测因素[比值比 = 3.47，95%置信区间（CI）：1.56 - 7.8，P = 0.002]。高IBIL水平的加入改善了预测模型的性能（净重新分类指数 = 0.186，95% CI：0.039 - 0.334；综合判别改善 = 0.0345，95% CI：0.005 - 0.065）。
术前高IBIL水平，尤其是超过正常上限的水平，可独立预测POMC的发生率。
