[1]崔新征),李立),杨鲲鹏),等.新的重症肌无力外科临床分型和分期的应用*[J].郑州大学学报(医学版),2012,(03):303.
 CUI Xinzheng),LI Li),YANG Kunpeng),et al.Application of a new clinical classification and stages in the surgery of patients with myasthenia gravis[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2012,(03):303.
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新的重症肌无力外科临床分型和分期的应用*
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《郑州大学学报(医学版)》[ISSN:1671-6825/CN:41-1340/R]

卷:
期数:
2012年03期
页码:
303
栏目:
专题研究
出版日期:
2012-05-20

文章信息/Info

Title:
Application of a new clinical classification and stages in the surgery of patients with myasthenia gravis
作者:
崔新征12)李立3)杨鲲鹏1)吉庆春1)兰红1)张清勇12)#
1)郑州大学第二附属医院胸外科 郑州 4500142)郑州大学生物医学工程研究所 郑州 4500143)河南省医学科学院 郑州 450003
Author(s):
CUI Xinzheng12)LI Li3)YANG Kunpeng1)JI Qingchun1)LAN Hong1)ZHANG Qingyong12)
1)Department of Thoracic Surgery, the Second Affiliated Hospital,Zhengzhou University, Zhengzhou 450014 2)Institute of Biological Medicine,Zhengzhou University, Zhengzhou 450014 3)Henan Academy of Medical Sciences, Zhengzhou 450003
关键词:
重症肌无力临床分型临床分期
Keywords:
myasthenia gravisclinical classificationclinical stage
分类号:
R593.2;R605
摘要:
目的:总结作者提出的新的重症肌无力(MG)临床分型和分期方法在外科治疗中的应用价值。方法:收集1998年1月至2007年12月收治的410例MG患者的病历资料,分3组,分别按作者提出的临床分型和分期方法(观察组,280例)、Osserman分型(对照1组,60例)和美国重症肌无力协会临床分型(对照2组,70例)进行术前分型,按所选分型方法指导手术适应证及时机的选择,均行胸腺(瘤)切除并前纵隔脂肪清扫术,比较术后肌无力危象的发生率以及手术死亡率,比较发生肌无力危象患者的术前分型和分期。结果:观察组术后危象的发生率为8.6%,对照1组为20.0%,对照2组为18.6%,与对照1、2组比较,观察组术后危象发生率明显降低(χ2=6.817和5.923,P均<0.05)。观察组发作/进展期患者肌无力危象发生率为23.2%(22/95),远高于稳定/缓解期的1.1%(2/185),差异有统计学意义(χ2=39.037,P<0.001)。3组患者手术死亡率均为0。结论:作者提出的MG临床分型和分期方法可指导手术适应证及时机的选择,有效降低术后肌无力危象的发生率。
Abstract:
Aim:To explore the clinical significance of a new clinical classification and stages published by author in the surgery of the patients with myasthenia gravis.Methods:From January 1998 to December 2007,410 myasthenia gravis patients who received thymectomy were classified with different clinical classification, such as Osserman classification (control one group,60 cases), Myasthenia Gravis Foundation of Amercia (MGFA) clinical classification (control two group, 70 cases) and a new clinical classification and stages published by author (observation group,280 cases). The differences among the three classifications were analyzed. The incidence of myasthenia crisis and mortality after thymectomy was also respectively studied.Results:The incidence of myasthenia crisis in observation group was 8.6%(24/280), it was significantly lower than that in control group one (20.0%,12/60) and two (18.6%,13/70).In observation group,the incidence of myasthenia crisis of the patients who were in attack/progress stage was significantly higher than those who were in stable/remissive stage (χ2=39.037,P<0.001). The incidence of mortality was 0 in three groups.Conclusion:The incidence of myasthenia crisis can be decreased according to the new clinical classification and stages published by author.

参考文献/References:

[1]Osserman KE.Myasthenia Gravis[M].New York:Grune & Stratton,1958:80
[2]Jaretzki A 3rd, Barohn RJ, Ernstoff RM,et al. Myasthenia gravis: recommendations for clinical research standards.[J].Ann Thorac Surg,2000,70(1):327
[3]Hennessey IA, Long AM, Hughes I,et al. Thymectomy for inducing remission in juvenile myasthenia gravis[J].Pediatr Surg Int,2011,27(6):591
[4]Chen Z, Luo H, Peng Y, et al. Comparative clinical features and immune responses after extended thymectomy for myasthenia gravis in patients with atrophic versus hyperplastic thymus[J].Ann Thorac Surg,2011,91(1):212
[5]Mao ZF, Yang LX, Mo XA,et al. Frequency of autoimmune diseases in myasthenia gravis: a systematic review[J]. Int J Neurosci,2011,121(3):121
[6]Angelini C. Diagnosis and management of autoimmune myasthenia gravis[J].Clin Drug Investig,2011,31(1):1
[7]DiazManera J, RojasGarcia R, Illa I. Treatment strategies for myasthenia gravis[J].Expert Opin Pharmacother,2009,10(8):1329
[8]张清勇,杨鲲鹏,苏彦河,等.重症肌无力患者围手术期管理[J].郑州大学学报:医学版,2005,40(1):11
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[10]Mandawat A, Kaminski HJ, Cutter G, et al. Comparative analysis of therapeutic options used for myasthenia gravis[J]. Ann Neurol,2010,68(6):797

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备注/Memo

备注/Memo:
*国家自然科学基金资助项目30570625 #通讯作者,男,1963年11月生,主任医师,教授,研究方向:重症肌无力的临床医学与发病机制,Email:qyzhang@zzu.edu.cn
更新日期/Last Update: 2012-05-31