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目的比较乙酰胆碱受体抗体(ACh R-Ab)阳性全身型重症肌无力(MG)与ACh R-Ab阴性全身型MG患者胸腺切除术的疗效。方法将124例于胸外科接受胸腔镜胸腺扩大切除术的全身型MG患者,根据术前血清ACh R-Ab表现,分为ACh R-Ab阳性组(81例)和ACh R-Ab阴性组(43例),比较两组患者的完全稳定缓解率。结果两组患者的性别、手术时年龄、术前病程、首发症状及胸腺病理类型等基本情况组间比较差异无显著性。术后ACh R-Ab阳性组失访1例,阴性组失访2例,共完成随访121例患者,随访时间15~84个月,其中ACh R-Ab阳性组80例,随访(44.9±19.9)个月,ACh R-Ab阴性组41例,随访(48.2±20.3)个月。术后完全稳定缓解率ACh R-Ab阳性组(48.8%)显著高于ACh R-Ab阴性组(26.8%),χ2=5.372,P=0.020。术后总有效率ACh R-Ab阳性组为95.0%,ACh R-Ab阴性组为90.2%,两组比较差异无统计学意义(χ2=0.993,P=0.319)。完全稳定缓解率的Kaplan-Meier生存曲线提示,随着术后随访时间的延长,完全稳定缓解率逐渐升高;Log-rank法比较两组之间的完全稳定缓解率均逐渐升高(P=0.03)。结论血清ACh R-Ab阳性患者胸腺扩大切除术后完全稳定缓解率优于ACh R-Ab阴性患者,随着随访时间的延长,完全稳定缓解率逐渐升高,但两组患者的总有效率类似。
Objective To compare the efficacy of thymectomy with ACh R-Ab positive systemic myasthenia gravis (MG) and ACh R-Ab negative whole body MG. Methods According to the results of preoperative serum ACh R-Ab, 124 patients with general-purpose MG who underwent thoracoscopic thymus enlargement resection in thoracic surgery were divided into ACh R-Ab positive group (81 cases) and ACh R-Ab negative group 43 cases). The complete stable response rate was compared between the two groups. Results There was no significant difference between the two groups in basic conditions such as gender, age at surgery, preoperative course, first symptom, and thymus pathological type. There were 1 case lost in ACh R-Ab positive group and 2 cases lost in negative group. A total of 121 patients were followed up for 15-84 months. The ACh R-Ab positive group was followed up (44.9 ± 19.9) ) Months, 41 cases of ACh R-Ab negative group were followed up (48.2 ± 20.3) months. The postoperative complete remission rate of ACh R-Ab positive group (48.8%) was significantly higher than ACh R-Ab negative group (26.8%), χ2 = 5.372, P = 0.020. The total effective rate was 95.0% in ACh R-Ab positive group and 90.2% in ACh R-Ab negative group, there was no significant difference between the two groups (χ2 = 0.993, P = 0.319). The Kaplan-Meier survival curves of patients with complete remission indicated that the complete remission rate increased with the extension of postoperative follow-up time. The complete remission rate of both groups was significantly increased by Log-rank test (P = 0.03). Conclusions The complete remission rate after thymus enlargement resection in patients with ACh R-Ab positive is better than ACh R-Ab negative patients. As the follow-up time prolongs, the complete stable remission rate gradually increases, but the total effective rate in both groups is similar .