【摘要】：研究目的:分析重癥肌無力(myasthenia gravis MG)患者的臨床、生化特點(diǎn),以及影響激素治療敏感性的相關(guān)因素,探索伴或不伴其他免疫疾病的MG兩者之間的差異,并探究MG與激素治療敏感性相關(guān)的預(yù)測因素。研究方法:回顧性分析2000年01月-2014年12月長海醫(yī)院神經(jīng)內(nèi)科及胸心外科確診的266例MG患者臨床與生化資料,根據(jù)是否合并其他免疫疾病,將患者分為不伴其他免疫疾病組與伴有其他免疫疾病組,分析兩組間的臨床、生化特征。根據(jù)激素治療后患者臨床癥狀改善狀況,將不伴其他自身免疫疾病MG患者分為激素治療敏感組與不敏感組,比較兩組間的臨床及生化特征。分析MG患者與激素治療反應(yīng)相關(guān)的臨床及生化因素。研究結(jié)果:病人總數(shù)266人,不伴其他免疫疾病組MG 171例,占64.3%,伴有其他免疫疾病組MG 95例,占35.7%。男性117例,占44.0%,女性149例,占56.0%。發(fā)病年齡1~83歲,平均發(fā)病年齡(44.23±18.5)歲。兩組間性別構(gòu)成、發(fā)病年齡、激素治療敏感性及紅細(xì)胞沉降率(ESR)水平比較有統(tǒng)計(jì)學(xué)差異(P0.05),兩組間前驅(qū)癥狀、起病方式、累及肌群、臨床分型、相關(guān)抗體陽性率、疲勞試驗(yàn)、新斯的明試驗(yàn)、重復(fù)電刺激、胸腺異常、高血壓病、藥物過敏、血糖異常、血脂異常、治療前白細(xì)胞(WBC)水平、C反應(yīng)蛋白(CRP)水平等比較無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。86例不伴其他自身免疫性疾病MG患者,根據(jù)激素治療后患者臨床癥狀改善狀況,將患者分為激素治療敏感組與不敏感組,兩組間胸腺異常比較有統(tǒng)計(jì)學(xué)差異(P0.05);伴胸腺異常組與無胸腺異常組之間激素治療敏感性比較有統(tǒng)計(jì)學(xué)差異(X~2=5.01,P=0.03);胸腺異常與激素治療不敏感發(fā)生率呈正相關(guān)(r=0.237,P=0.03)。63例不伴其他自身免疫性疾病MG患者使用大劑量激素短程沖擊治療并在治療前檢測血脂水平,根據(jù)激素治療后患者臨床癥狀改善狀況,將患者分為激素治療敏感組與不敏感組,兩組間血脂異常、總膽固醇(TC)、低密度脂蛋白膽固醇(LDL-C)等特征比較有統(tǒng)計(jì)學(xué)差異(P0.05);血脂正常組與血脂異常組之間激素治療敏感性比較有統(tǒng)計(jì)學(xué)差異(X~2=9.31,P0.01);血脂異常與激素治療不敏感發(fā)生率呈正相關(guān)(r=0.384,P0.01)。研究結(jié)論:伴有其他自身免疫性疾病的MG患者較不伴其他自身免疫性疾病的MG患者女性更為多見,發(fā)病年齡較早,激素治療敏感性好,ESR水平升高明顯。不伴其他自身免疫性疾病的MG患者激素治療效果與胸腺病理及血脂水平相關(guān),胸腺異常、血脂升高均降低激素治療療效,兩者之間的關(guān)系有助于MG患者的臨床治療評(píng)估及預(yù)后判斷。
[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 鹵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.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R746.1

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