Yoshitake T, Takahama T, Kanai F, Ohnishi K, Tamura K, Suzuki T, Kametani Y, Kataoka D, Nakata H, Itoyama S
Department of Surgery, Saitama Medical Center, Japan.
Kyobu Geka. 1995 Jun;48(6):447-51.
Thirty nine thymus tissues from myasthenia gravis patients without thymoma who underwent extended thymectomy were evaluated on thymic lymphoid hyperplasia with special emphasis on clinical features and the efficacy of thymectomy. Of 39 patients, 31 were women, but 3 of 7 patients without thymic lymphoid hyperplasia were men. The hyperplastic index of the thymus correlated largely with serum anti-Ach-R antibody titers before surgery. Age, myasthenic type and preoperative duration of the symptoms were almost unrelated to the hyperplastic change in the thymus. The effect of thymectomy was more remarkable in the patients with the hyperplastic thymus than that in them without it, who obtained still no remission after surgery, although the remission rate of them with it reached to 25%. Of 7 patients without the hyperplastic thymus, 4 had no detectable antibody to acetylcholine receptor, whereas in 32 patients with it only 2 were seronegative. This negative immunological factor might make adverse response to thymectomy. Although unfavorable response to thymectomy were observed in the patients without the hyperplastic thymus, most of them were significantly improved through a supplementary treatment with steroid after surgery. Thymectomy was a favorable treatment for myasthenia gravis patients with thymic lymphoid hyperplasia, whereas in them without it the result of thymectomy was unsatisfactory.
对39例无胸腺瘤的重症肌无力患者进行了扩大胸腺切除术，并对其胸腺淋巴样增生情况进行了评估，特别关注临床特征和胸腺切除术的疗效。39例患者中，31例为女性，但7例无胸腺淋巴样增生的患者中有3例为男性。胸腺的增生指数与术前血清抗乙酰胆碱受体抗体滴度密切相关。年龄、肌无力类型和术前症状持续时间与胸腺的增生性改变几乎无关。胸腺增生的患者胸腺切除术后效果比无胸腺增生的患者更显著，无胸腺增生的患者术后仍未缓解，尽管有胸腺增生的患者缓解率达到25%。7例无胸腺增生的患者中，4例检测不到乙酰胆碱受体抗体，而32例有胸腺增生的患者中只有2例血清学阴性。这种阴性免疫因素可能导致对胸腺切除术产生不良反应。虽然无胸腺增生的患者对胸腺切除术反应不佳，但大多数患者术后通过补充类固醇治疗有明显改善。胸腺切除术对有胸腺淋巴样增生的重症肌无力患者是一种有效的治疗方法，而对无胸腺增生的患者，胸腺切除术的效果并不理想。
