重症肌无力患者激素治疗敏感性相关因素分析

发布时间：2018-07-20 19:31

【摘要】：研究目的:分析重症肌无力(myasthenia gravis MG)患者的临床、生化特点,以及影响激素治疗敏感性的相关因素,探索伴或不伴其他免疫疾病的MG两者之间的差异,并探究MG与激素治疗敏感性相关的预测因素。研究方法:回顾性分析2000年01月-2014年12月长海医院神经内科及胸心外科确诊的266例MG患者临床与生化资料,根据是否合并其他免疫疾病,将患者分为不伴其他免疫疾病组与伴有其他免疫疾病组,分析两组间的临床、生化特征。根据激素治疗后患者临床症状改善状况,将不伴其他自身免疫疾病MG患者分为激素治疗敏感组与不敏感组,比较两组间的临床及生化特征。分析MG患者与激素治疗反应相关的临床及生化因素。研究结果:病人总数266人,不伴其他免疫疾病组MG 171例,占64.3%,伴有其他免疫疾病组MG 95例,占35.7%。男性117例,占44.0%,女性149例,占56.0%。发病年龄1~83岁,平均发病年龄(44.23±18.5)岁。两组间性别构成、发病年龄、激素治疗敏感性及红细胞沉降率(ESR)水平比较有统计学差异(P0.05),两组间前驱症状、起病方式、累及肌群、临床分型、相关抗体阳性率、疲劳试验、新斯的明试验、重复电刺激、胸腺异常、高血压病、药物过敏、血糖异常、血脂异常、治疗前白细胞(WBC)水平、C反应蛋白(CRP)水平等比较无明显统计学差异(P0.05)。86例不伴其他自身免疫性疾病MG患者,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,两组间胸腺异常比较有统计学差异(P0.05);伴胸腺异常组与无胸腺异常组之间激素治疗敏感性比较有统计学差异(X~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)。63例不伴其他自身免疫性疾病MG患者使用大剂量激素短程冲击治疗并在治疗前检测血脂水平,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,两组间血脂异常、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)等特征比较有统计学差异(P0.05);血脂正常组与血脂异常组之间激素治疗敏感性比较有统计学差异(X~2=9.31,P0.01);血脂异常与激素治疗不敏感发生率呈正相关(r=0.384,P0.01)。研究结论:伴有其他自身免疫性疾病的MG患者较不伴其他自身免疫性疾病的MG患者女性更为多见,发病年龄较早,激素治疗敏感性好,ESR水平升高明显。不伴其他自身免疫性疾病的MG患者激素治疗效果与胸腺病理及血脂水平相关,胸腺异常、血脂升高均降低激素治疗疗效,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。
[Abstract]:Objective: to analyze the clinical and biochemical characteristics of patients with myasthenia gravis (myasthenia gravis MG) and the related factors affecting the sensitivity of hormone therapy, and to explore the difference between MG patients with or without other immune diseases. And to explore the predictors of MG and hormone sensitivity. Methods: the clinical and biochemical data of 266 patients with MG diagnosed by Department of Neurology and Thoracic Cardiac surgery in Changhai Hospital from January 2000 to December 2014 were retrospectively analyzed. The patients were divided into two groups: those without other immune diseases and those with other immune diseases. The clinical and biochemical characteristics of the two groups were analyzed. According to the improvement of clinical symptoms after hormone therapy, MG patients without other autoimmune diseases were divided into sensitive group and insensitive group. The clinical and biochemical characteristics of the two groups were compared. To analyze the clinical and biochemical factors related to hormone therapy in MG patients. Results: the total number of patients was 266. There were 171 cases of MG without other immune diseases (64.3%) and 95 cases (35.775%) of MG with other immune diseases. There were 117 males (44.0%) and 149 females (56.0%). The mean age of onset was (44.23 卤18.5) years. There were significant differences in sex composition, onset age, hormone sensitivity and erythrocyte sedimentation rate (ESR) between the two groups (P0.05). Neostigmine test, repetitive electrical stimulation, thymic abnormalities, hypertension, drug allergy, abnormal blood sugar, dyslipidemia, There was no significant difference in WBC level and C-reactive protein (CRP) level before treatment (P0.05). 86 patients with MG without other autoimmune diseases were treated with hormone according to the improvement of clinical symptoms. The patients were divided into sensitive group and insensitive group. There was significant difference between the two groups in thymus abnormality (P0.05), the sensitivity of hormone therapy between the group with thymus abnormality and the group without thymus abnormality was statistically different (XP0. 03), and there was a positive correlation between the abnormal thymus and the incidence of insensitivity to hormone therapy (r = 0. 237P = 0. 03) .63 cases without thymus abnormality. Patients with other autoimmune diseases MG were treated with high-dose hormone short-range impulse therapy and blood lipid levels were measured before treatment. According to the improvement of clinical symptoms after hormone therapy, the patients were divided into two groups: sensitive group and insensitive group. Total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were significantly different (P0.05); there were significant differences in the sensitivity of hormone therapy between normal blood lipid group and dyslipidemia group (XG 29.31 P 0.01); and there was a positive correlation between dyslipidemia and the incidence of hormone insensitivity (r = 0.384 P 0.01). Conclusion: MG patients with other autoimmune diseases are more common than those without other autoimmune diseases. The effect of hormone therapy on MG patients without other autoimmune diseases was related to thymus pathology and blood lipid level. The relationship between the two is helpful to the evaluation of clinical treatment and prognosis of MG patients.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R746.1

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