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目的确定静脉注射低渗对比剂与重症肌无力病人病情进展是否相关。材料与方法本研究经机构审查委员会批准,符合HIPAA标准,并免除知情同意书。1995年1月1日—2011年12月31日间,临床确诊的267例重症肌无力病人均行CT检查,其中155例无静脉对比剂注射,112例经静脉注射低渗对比剂。每次CT检查前(≤14d)和检查后(≤45d)均通过检索电子病案确定重症肌无力相关症状。应用Mantel-Coxlogrank检验比较组间症状进展时间。应用Fisher确切检验比较3个时间段疾病相关症状的发生率:(a)CT检查后0~1d,(b)CT检查后2~7d,(c)CT检查后8~45d。结果 CT检查前,非增强组与增强组有相近的胸腺切除率(P=0.97)及疾病相关症状(P=0.58)。CT检查后,增强CT组疾病相关症状进展时间显著缩短(增强CT组距症状进展出现的中位数时间为2.5d,非增强CT组为14d,P=0.05)。与非增强CT组相比,增强CT组检查后1d内疾病相关症状恶化显著增多[6.3%(7/112例)∶0.6%(1/155例);P=0.01]。急性恶化主要累及呼吸道[5例病人为新发呼吸困难(增强CT组4例,非增强CT组1例)],2例病人为进行性呼吸困难(均出现在增强CT组),1例病人为进行性无力(增强CT组)。两组间2~7d及8~45d症状差异无统计学意义(P=0.99)。结论静脉注射低渗对比剂与重症肌无力病人症状恶化显著相关。最常见的恶化表现为新发的或进展性的急性呼吸困难。
Objective To determine whether intravenous infusion of hypotonic contrast agent is associated with progression of the disease in patients with myasthenia gravis. Materials and Methods The study was approved by the Institutional Review Board and conformed to the HIPAA standard and was exempt from informed consent. Between January 1, 1995 and December 31, 2011, a total of 267 patients with myasthenia gravis diagnosed clinically underwent computed tomography (CT) examination, including 155 without intravenous contrast agent and 112 with intravenous hypotonic contrast agent. Before each CT examination (≤ 14d) and after examination (≤ 45d) were identified by electronic medical records to determine the symptoms associated with myasthenia gravis. Mantel-Coxlogrank test was used to compare the symptom progression time between groups. Fisher’s exact test was used to compare the incidence of disease-related symptoms in three time periods: (a) 0 to 1 day after CT examination, (b) 2 to 7 days after CT examination, and (c) 8 to 45 days after CT examination. Results Before CT, there was a similar rate of thymectomy (P = 0.97) and disease-related symptoms (P = 0.58) in the non-enhancement and enhancement groups. After CT examination, the time to progression of disease-related symptoms in CT group was significantly shortened (median time to enhance symptom progression was 2.5 days in CT group and 14 days in non-enhanced CT group, P = 0.05). Compared with non-enhanced CT group, the worsening of disease-related symptoms were significantly increased within 1d after intensive CT examination (6.3% (7/112 cases): 0.6% (1/155 cases; P = 0.01]. Acute exacerbations mainly involved the respiratory tract [5 patients had newly developed dyspnea (4 in the enhanced CT group and 1 in the non-enhanced CT group)], 2 were progressive dyspnea (all in the enhanced CT group), and 1 patient For progressive weakness (enhanced CT group). There were no significant differences in symptoms between 2 ~ 7 days and 8 ~ 45 days (P = 0.99). Conclusions Intravenous hypotonic contrast agents are significantly associated with worsening symptoms in patients with myasthenia gravis. The most common worsening manifested as new or progressive acute dyspnea.