| PurposeMyasthenia gravis (MG) is a neuromuscular chronic disorder manifested by weakness and fatigability of voluntary muscles. It has become clear that the basic defect in the disease is a reduction of available acetylcholine receptors (AchR) at neuromuscular junction, bought by an autoimmune attack related with cell immune and complement system.In spite of the pathogenesis of MG is not completely clear still now, recently a lot of researches manifest the thymus is tightly involved and plays in key role. The thymectomy just cuts the connection between MG and thymus. Along with the development of the technique of anaesthesia ,way of surgery and postoperative management, today thymectomy combined medical therapy have become one of the most effective therapeutic strategy for patients with MG. A meta-analysis of long-term results showed that 90% of the patients who underwent the surgery improved, and 50% achieved a complete remission. However, there were still some patients who showed no change or deteriorated and even died soon after surgery, for the complexity of MG in pathogenesis and the individual difference of patients. Generally the status does not gradually stable until two years after operation, and 90% of remission after five years. Therefore, to properly estimate the postoperative prognosis and to decide which cases tobe operated on are the keys to enhance MG patient remission.We analyzed retrospectively the clinical and follow-up data of 158 patients who wear operated by thymectomy at out department to find the factors which affect the distant prognosis after operation. And the study to factors affecting prognosis must come down to the research of pathogenesis. In the article, we took part sample out of 158 patients to exam the expression level of Bcl-2 and Fas in myasthenic thymus tissue, and to find the role of which in whole pathogenesis. we also try to find the role of neopterin and sIL-2R through examing the concentration of neopterin and sIL-2R in peripheral blood of 26 MG patients. Material and methods1.select of case: to choose 158 patients who wear followed up from 1988 to 2002 after operation. All patients were diagnosed as MG, and treated with same medical cure during period of preoperation and post operation. 2.Collectionofdata:(l).To collect all data through designing a uniform follow-up table for thymectomized patients ,and to analysis the effect of factors including age, gender, disease duration of preoperation, clinic types and pathological types to prognosis at three follow-up period? to 2 years, 2-5 years, 5-10 years after thymectomy.(2). According the results of examination of Bcl-2, fas, germinal center, and neopterin, SIL-2R, we concluded the probably role of these in pathogenesis of MG .(3).Statistics: Logistic regression model analyzed the related factors and nonparameter statistics analyzed diffence and relation ties. Result(l).By the Logistic regression statistical model, we conclude: clinical type, the duration of preoperation and pathological type all affect the prognosis of thymectomy. But there isdifferent among three follow-up period. During the first 2 years, the clinc type was the most effective factors, but after 2 years of follow-up, the pathological type became the key factors. Calculative model of Logistic regression : During 2 years after operationp0. 491+1. 029X3+0. 902X4-0. 832X5 0. 491+1. 029X3+0. 902X4-0. 832X5 During 2 to 5 years after operationp_ 1. 276+1. 001X4-0. 978X5 1. 276+1. 001X4-0. 978X5During 5 to 10 years after operationcode p as remission rate(if remission p=0 or p=l) ;code X3 as clinic type, codeX4 as preoperative duration, code X5 as pathological type(3).The duration more long, the prognosis more worse. The prognosis of the I and Ha clinicaltype were obviously better than other types. The prognosis differed among the differentpathological types and thymoma was worst Age, gender, and histological type were notrelated with prognosis in statistics.(4).The expression of Bcl-... |
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