為了比較眼部與全身性兩型重症肌無力的關係及治療成效，本文回收集65例重症肌無力，平均追蹤30.4個月。35例侷限眼部，另30例則為全身性發展。比較項目包括性別、年齡、臨床症狀、血清抗體指數，與胸腺之關聯及治療效果。結果顯示，全身性重症肌無力患者中，男性的年齡顯著大於女性，眼瞼下垂及複視是最多的症狀，所侵犯的眼外肌以提眼臉肌及外直肌最多。全身性重症肌無力患者，合併胸腺瘤或胸腺增生的情形，顯著多於眼部重整肌無力，且在年青人亦顯著多。Neostigmine測試之限性率為93.8%。乙酸膽鹼受體抗體之陽性率平均為81.1%，且全身性重症肌無力患者的陽性率顯著較高（96.2% vs 66.7%）兩型重症肌無力患者的藥物治療成效並無差別。16位接受胸腺切除之患者，只有2位完全痊癒且不再仰賴藥物。無論從臨床表現或治療成效來看，兩種型態重症肌無力患者的界線仍模糊，此兩型可能有相同的特質且差別在於疾病程度的嚴重性。胸腺切除術對重症肌無力患者的治療上的效益，仍有進一步探討的必要。
We compared the relations and therapeutic outcomes of ocular and generalized types of myasthenia gravis (MG) and used retrospective analysis for 65 patients with myasthenia gravis during a mean follow-up time of 30.4 months. There were 35 ocular and 30 generalized MG patients. Items of comparison included sex, age clinical presentations, serum antibody titer, the association with thymus status, and therapeutic outcome. Of the patients with generalized MG, males were significantly older than females. Ptosis and diplopia were the most common symptoms in patients with MG, but there were no significant differences between the two types of MG. The eyelid levator muscles and lateral rectus muscle were the most commonly involved extraocular muscles in patients with MG. The associations with thymoma or thymus hyperplasia were more common in generalized MG than in ocular MG, and more common in younger than in older patients. The result of positive neostigmine test was 93.8% in all patients, but there were no significant differences between the two types of MG. Acetylcholine receptor antibody (AchRAb) presented an 81.1% positive rate and was significantly higher in generalized MG than that in ocular MG (96.2% vs 66.7%). There were no significant differences between the two types of MG regarding successful treatment strategies in both initial therapy and maintenance therapy. Only two of 16 patients had complete remissions after thymectomy. From the viewpoint of clinical presentations or from the therapeutic strategy outcome, the boundary between both types of MG seems to be vague. Both types of MG probably share the same entity in nature and the difference is just a matter of degree of severity. The benefit of thymectomy in treatment of MG needs further investigation.
關聯:
The Kaohsiung Journal of Medical Sciences 18卷2期 P.62-69
