【摘要】：目的： 1.觀察伴有胸腺瘤的重癥肌無力患者(myasthenia gravis with thymoma，MGT)環(huán)磷酰胺（Cyclophosphamide，CTX）治療的療效及副作用； 2.探討MGT使用CTX治療前后重復頻率電刺激（repetitive nerve stimulation，RNS）的變化規(guī)律。 方法： 1.所有研究對象來源于2006年12月至2013年8月第二炮兵總醫(yī)院神經(jīng)內(nèi)科就診的MGT患者，經(jīng)篩查共有62例MGT患者接受CTX治療直至研究結(jié)束，男34例，女28例，納入時最小年齡20歲，最大年齡78歲，平均年齡(46.29±11.672)歲，平均病程(49.53±37.49)月，其中A型胸腺瘤5例，AB型胸腺瘤4例，B1型胸腺瘤21例，B2型胸腺瘤15例，B3型胸腺瘤10例，B1、B2混合型5例，B2、B3混合型2例。入院時MG改良Osserman分型Ⅰ型6例，ⅡA型13例，ⅡB型24例，Ⅲ型9例，Ⅳ型10例。 2.予以CTX0.2g/次靜滴2次/第一周，0.4g/次靜滴2次/第二周，0.8g/次靜滴1次/周至總量10g。用藥開始前及結(jié)束后完善重癥肌無力臨床絕對評分及RNS檢查。根據(jù)重癥肌無力的臨床絕對評分和臨床相對評分評定療效。國外多項回顧性研究認為B2型，B3型胸腺瘤比A型、AB型、B1型胸腺瘤更具侵襲性，而腫瘤的侵襲性是區(qū)分良惡性腫瘤的標準之一，因此將胸腺病理分型為A型，AB型，B1型分為惡性程度較低組，病理分型是B2型，B3型，B1、B2混合型，B2、B3混合型者分為惡性程度較高組，比較兩組間療效的差異性，并觀察部分患者治療前后RNS檢查的變化規(guī)律。 3.療效判定：評定臨床絕對評分記錄患者肌無力和易疲勞性的嚴重程度。根據(jù)MG的相對評分法評定療效。具體計算方法為：重癥肌無力臨床相對計分=（治療前總分－治療后總分）/治療前總分×100％，相對評分≥95％者為痊愈，80％～95％者為基本痊愈，50％～80％者為顯效，25％～50％者為好轉(zhuǎn)，≤25％者為無效�？傆行�=（痊愈+基本痊愈+顯效+好轉(zhuǎn)）人數(shù)/入組人數(shù)。 結(jié)果： （1）62例MGT患者使用CTX治療前后臨床絕對評分明顯下降，差異有統(tǒng)計學意義，提示環(huán)磷酰胺治療有效，臨床治療總有效率達85%（53/62）。 （2）2組MGT患者臨床相對評分分別記為(0.59±0.28)、(0.61±0.31)，差異無統(tǒng)計學意義。 （3）本研究所使用的CTX治療方法僅有白細胞輕度下降，惡心、嘔吐，轉(zhuǎn)氨酶輕度升高等副作用，，副作用輕微，患者耐受性好。 （4）對其中23例患者RNS結(jié)果進行分析，治療后RNS低頻衰減幅度較治療前顯著減少，治療前后的差異具有統(tǒng)計學意義，說明治療有效。 結(jié)論： （1）采用本方法治療MGT患者安全有效，但是本研究中患者療效的評定以CTX總量達到10g為節(jié)點，其中部分患者因臨床仍有肌無力癥狀而繼續(xù)使用CTX，之后的療效評估尚需進一步研究。 （2）CTX對不同病理分型胸腺瘤的療效無統(tǒng)計學差異，提示胸腺瘤病理的分型可能與CTX治療療效無關(guān)，但是由于本研究樣本量小，觀察時間短， CTX療效差異性可能尚未顯現(xiàn)，有待加大樣本量及延長觀察時間。 （3）CTX治療后，患者RNS低頻波幅衰減程度減少，與重癥肌無力臨床絕對評分好轉(zhuǎn)相一致，因此可作為CTX治療重癥肌無力伴胸腺瘤患者療效的監(jiān)測指標。
[Abstract]:Objective:
1. to observe the efficacy and side effects of myasthenia gravis with thymoma (MGT) cyclophosphamide (Cyclophosphamide) in patients with thymoma.
2. to explore the changes of repetitive nerve stimulation (RNS) in MGT before and after CTX treatment.
Method:
1. all the subjects were derived from the MGT patients in the neurology department of the Second Artillery General Hospital from December 2006 to August 2013. There were 62 cases of MGT patients receiving CTX treatment until the end of the study. There were 34 males and 28 females. The minimum age was 20 years, the maximum age was 78, the average age was (46.29 + 11.672) years, and the average course of disease was 49.53 + 37.49 months. 5 cases of middle A thymoma, 4 cases of type AB thymoma, 21 cases of B1 thymoma, 15 cases of B2 thymoma, 10 cases of B3 thymoma, 5 cases of B2 mixed type, B2 and 2 B3 mixed type, MG modified Osserman classification I 6 cases, 13 cases of A type, 24 cases of A type, 9 cases of type III and 10 cases of type IV.
2. CTX0.2g/ intravenous drip for 2 times / first week, 0.4g/ drop for 2 times / second weeks, 0.8g/ time drop 1 times per week before and after the total of 10g. medication, the clinical absolute score and RNS examination of myasthenia gravis were perfected. The clinical absolute score and clinical relative score of myasthenia gravis were evaluated and the curative effect was determined. A number of foreign retrospective studies considered B2, B Type 3 thymoma is more invasive than type A, type AB, B1 type thymoma, and the invasiveness of the tumor is one of the criteria for differentiating benign and malignant tumors. Therefore, the thymus is classified as A, AB and B1 into low malignancy, and the pathological type is B2, B3, B1, B2 mixed and B2, and B3 mixed type is divided into higher level of malignant degree, compared with the two groups. The changes of RNS in some patients before and after treatment were observed.
3. evaluation of curative effect: evaluate the severity of myasthenia and fatigue of patients by clinical absolute score. According to the relative score of MG, the clinical relative score of myasthenia gravis = (total score before treatment) / total score before treatment (total score) / 100%, relative score of more than 95% were cured, 80% to 95% For the basic recovery, 50% to 80% were effective, 25% to 50% were improved and less than 25% were ineffective. The total effective rate = (recovery + basic recovery + improved + improvement) number / entry group.
Result:
(1) the clinical absolute score of 62 patients with MGT was significantly decreased before and after the use of CTX. The difference was statistically significant, suggesting that cyclophosphamide was effective and the total effective rate of clinical treatment was 85% (53/62).
(2) the clinical relative scores of the 2 groups of MGT patients were respectively (0.59 + 0.28), (0.61 + 0.31), and the difference was not statistically significant.
(3) the CTX treatment used in this study is only mild leukocyte reduction, nausea and vomiting, mild side effects of aminotransferase, mild side effects, and good tolerance.
(4) the results of RNS in 23 of the patients were analyzed. The low frequency attenuation amplitude of RNS was significantly reduced after treatment, and the difference before and after treatment was statistically significant, indicating that the treatment was effective.
Conclusion:
(1) the treatment of MGT patients with this method is safe and effective, but in this study, the evaluation of the curative effect of this study is that the total amount of CTX is 10g as the node, and some of the patients continue to use CTX because of the clinical myasthenia symptoms, and the evaluation of the curative effect needs further study.
(2) there is no statistical difference in the effect of CTX on different pathological types of thymoma. It is suggested that the pathological classification of thymoma may not be related to the therapeutic effect of CTX. However, because of the small sample size, short observation time, the difference of CTX effect may not be revealed, and it needs to increase the sample size and prolonged observation time.
(3) after CTX treatment, the attenuation of low frequency amplitude of RNS decreased and was consistent with the improvement of clinical absolute score of myasthenia gravis, so it could be used as a monitoring index for the therapeutic effect of CTX in the treatment of myasthenia gravis and thymoma.
【學位授予單位】：蘇州大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R736.3;R746.1

【參考文獻】

相關(guān)期刊論文 前10條

1 凌亞興 ,肖衛(wèi)民;環(huán)磷酰胺合強的松治療耐受糖皮質(zhì)激素重癥肌無力的臨床研究[J];臨床醫(yī)學;2003年08期

2 乞國艷;張獻波;鄭旭光;王峰;;重癥肌無力胸腺切除術(shù)后復發(fā)放射治療12例[J];河北醫(yī)藥;2009年23期

3 劉恒軍;大劑量環(huán)磷酰胺減少重癥肌無力危象的作用[J];河南醫(yī)藥信息;2003年04期

4 陳玉萍;魏東寧;肖漓;;重癥肌無力患者外周血T淋巴細胞亞群分布特點及臨床意義[J];醫(yī)學研究生學報;2011年09期

5 張潤希,李保華,徐金枝,楊明山;胸腺放射治療重癥肌無力的療效觀察[J];臨床神經(jīng)病學雜志;2002年02期

6 范偉女;洪文軻;;環(huán)磷酰胺或硫唑嘌呤對耐受糖皮質(zhì)激素重癥肌無力的療效觀察[J];現(xiàn)代實用醫(yī)學;2009年05期

7 朱惠民;張旭;陳根強;夏君慧;楊開顏;葉好好;;胸腺瘤WHO組織學分型與胸腺瘤診治的關(guān)系[J];中華全科醫(yī)學;2009年12期

8 梁銀杏;葛輝;姚曉黎;廖松潔;;重癥肌無力伴胸腺瘤或胸腺增生患者神經(jīng)電生理特點及手術(shù)的影響[J];西部醫(yī)學;2010年08期

9 胡玉林,張大昕,賀曉慧,崔守仁,王瑞芝,高永君;胸腺瘤術(shù)后放射治療的臨床意義[J];中華放射腫瘤學雜志;2003年04期

10 王秀云,許賢豪,孫宏,韓雄,張華,國紅;重癥肌無力病人的臨床絕對評分法和相對評分法[J];中華神經(jīng)科雜志;1997年02期

本文編號：2121857