晚发型重症肌无力的临床特点及预后研究

摘要

目的:研究晚发型重症肌无力(LOMG)患者的临床特点,初步探索其预后影响因素.方法:收集发病年龄≥50岁的MG患者191例,记录患者的性别、发病年龄、起始症状、Osserman分型、胸腺类型、乙酰胆碱受体抗体(AChR-Ab)、治疗情况等临床资料,综合分析LOMG的临床特点,并随访其治疗反应性.结果:LOMG发病年龄分布在50～82岁,女性(58.16％)略多于男性,眼肌症状为最常见的首发症状(80.63％),临床分型以全身型为主(58.11％),胸腺瘤(31.41％)、危象(13.61％)、AChR-Ab阳性(78.01％)比例高,且伴发疾病多,治疗有效性低(81.15％),亚组分析显示≥60岁组治疗后状态更差(P＜0.05).结论:LOMG具有发病率逐年上升、胸腺瘤发生率高、药物疗效不佳、合并症多、医疗负担重等特点,年龄为影响其治疗反应的最主要因素.%Objective:To investigate the clinical characteristics of late-onset myasthenia gravis,and to explore the prognostic factors preliminarily.Methods:Of 191 myasthenic patients followed with onset after age 50,we recorded the patients' gender,onset age,initial symptom,Osserman classification,type of pathology of the thymus,AChR-Ab,treatment and other clinical data.To analyse their clinical characteristics comprehensively and follow up their response to treatment.Results:The distribution of onset age in LOMG varied from 50 to 82,and female patients (58.16％) were somewhat more than male patients,with the main initial symptom involving ocular muscles (80.63％) and main clinical classification of generalized type (58.11％).The rate of thymoma (31.41％),crisis (13.61％) and AChR-Ab-positive (78.01％) are high,with high comorbidity rate and low favorable effect rate (81.15％).Subgroup analysis showed a poorer result in onset after age 60 (P＜0.05).Conclusion:LOMG incidence increased year by year with high thymoma incidence,poor therapy result,high comorbidity rate,heavy medical burden,ect.Age is the most important factors affecting the response to treatment.