摘要
目的比较胸腺切除与药物治疗对儿童型重症肌无力(myasthenia gravis,MG)的疗效。方法随访38例行胸腺扩大切除术及45例经药物治疗的5～14岁MG患儿的治疗效果。在接受手术/药物治疗前、治疗后3周、治疗后1年3个时间点检测MG患儿外周血淋巴细胞亚群比例。结果手术组完全缓解率(1年:47.4%vs.20.0%;2年:55.3%vs.22.2%)和总有效率(1年:71.1%vs.48.9%;2年:81.6%vs.55.5%)明显优于药物治疗组,差异有统计学意义(P﹤0.05);手术组第2年无效率显著降低,差异有统计学意义(P﹤0.05);两组恶化率的差异无统计学意义。与正常对照组比较,MG患儿治疗前外周血CD8+T细胞百分比显著降低,外周血CD4+/CD8+显著升高,差异有统计学意义(P﹤0.05)。手术组1年后CD4+/CD8+较治疗前明显下降,差异有统计学意义(P﹤0.05)。结论胸腺切除治疗儿童型MG能够提高临床缓解率,改善患儿预后。
Objective To evaluate the benefit of thymectomy in children with myasthenia gravis（MG）.Methods Over a period of 2 years from 2008 to 2011,the data of a total of 83 children（5～14 years）with MG were collected,including 38 patients with thymectomy and 45 with drug treatment.Thymectomy versus drug treatment for the rates of remission,improvement,no change and deterioration（remission and improvement were regarded as effective）were compared.The percentages of CD4＋ and CD8＋ T cells at different period after thymectomy or drug treatment were also measured.Results The children who underwent thymectomy had significantly higher rate of remission and more effective compared with drug treatment during a mean follow-up period of 24 months.There were no significant changes in the rates of no change and deterioration after the two approaches of treatment for MG.The percentage of CD8＋ T cells was significantly decreased and the ratio of CD4＋/CD8＋ T cells was increased in the MG group compared to the controls while there was no statistically significant difference in the percentage of CD4＋ T cells between the two groups.The ratio of CD4＋/CD8＋ T cells was decreased at the 1 year follow-up in children with MG received thymectomy.Conclusion Thymectomy appears to provide a high rate of remission and improvement in children with MG.It suggests that MG can be actively managed in children using thymectomy,with better chance for a good outcome.
出处
《北京医学》
CAS
2013年第5期339-341,共3页
Beijing Medical Journal
关键词
重症肌无力
儿童
胸腺切除术
预后
Myasthenia gravis（MG）Children Thymectomy Prognosis
