伴胸腺异常重症肌无力患者对糖皮质激素治疗的反应性

目的探讨不伴其他自身免疫性疾病的重症肌无力(MG)患者胸腺异常对糖皮质激素治疗的反应性及其临床意义。方法回顾性分析2000-01—2014-12长海医院神经内科确诊并使用糖皮质激素治疗的86例MG不伴免疫性疾病患者的临床与生化检查结果资料,根据激素治疗后患者临床症状改善状况,将患者分为激素治疗敏感组与不敏感组,并比较两组间的临床及生化检查结果特征;根据是否伴有胸腺异常分为无胸腺异常组与伴胸腺异常组,比较两组间激素治疗的反应性;分析MG患者胸腺异常与激素治疗反应的相关性。结果激素治疗敏感组与不敏感组间患者性别、年龄50岁、病程3年、起病方式、上呼吸道感染、肠道泌尿道感染、累及肌群、血糖异常比例以及白细胞、C反应蛋白、红细胞沉降率水平比较差异无统计学意义(P0.05),两组间胸腺异常、血脂异常患者比例比较有统计学差异(P0.05);伴胸腺异常组与无胸腺异常组间激素治疗敏感者比例比较有统计学差异(χ~2=5.01,P=0.03);胸腺异常与激素治疗不敏感发生率呈正相关(r=0.237,P=0.03)。结论胸腺异常降低MG不伴免疫性疾病患者对激素治疗的疗效,认识两者之间的关系有助于MG患者的临床治疗评估及预后判断。

The response of myasthenia gravis patients with thymus abnormality to glucocorticoid treatment

ABSTRACT:Objective To explore the correlation between abnormal thymus gland and response to glucocorticoid in myasthenia gravis (MG ) patients without autoimmune diseases. Methods Clinical and biochemical data of 86 MG patients ,without autoimmune diseases in the department of neurology from January 2000 to December 2014 , were retrospectively analyzed. According to clinical symptoms and response to glucocorticoid , MG patients were divided into the sensitive and resistant groups , and their clinical and biochemical characteristics were compared between the two groups.According to the status of thymus gland ,MG patients were divided into the normal and abnormal thymus gland groups , and the sensitivity to glucocorticoid was compared between the two groups. The correlation between the abnormal thymus gland and response to glucocorticoid was analyzed. Results Between the sensitive and resistant groups , there were no significant differences in gender ,age (less than 50 years old) , course of disease (less than 3 years) , mode of onset , respiratory infection ,the intestinal and urinary tract infection ,muscles involved ,white blood cell (WBC) ,C reactive protein (CRP) ,erythrocyte sedimentation rate (ESR) and proportion of abnormal blood glucose (P>0.05) .There were statistically significant differences in abnormal thymus and serum lipid level (P< 0.05). Between the normal and abnormal thymus groups , there were statistically significant differences in the response to glucocorticoid (χ2 =5.01 , P=0.03) . The occurrence of resistance to glucocorticoid was positively correlated with abnormal thymus gland (r= 0.237 , P= 0.03) . Conclusions Abnormal thymus gland may reduce the effectiveness of glucocorticoid treatment in MG patients without autoimmune diseases , and understanding the relationship may be beneficial to determine the clinical treatment and prognosis of MG patients.