To Explore The Value Of The Preoperative Medication Of Qiangji Jianli Tang For The Myasthenia Gravis Patients Underwent Extended Thymectomy

BackgroundMyasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular transmission, leading to generalized or localized weakness characterized by fatigability, the exact pathogenesis of this disease remained unclear.Some research indicate that thymus is the main place responsible for this autoimmune disorder. Thymectomy plays an important role in patients with myasthenia gravis. Postoperative myasthenic crisis is a complication of myasthenia gravis characterized by worsening of muscle weakness, resulting in respiratory failure that requires intubation and mechanical ventilation.Qiangji Jianli capsule orQiangji Jianli Tang is a drug consisting of some medicinal herb, which has been used in the treatment of MG for many years. Because its satisfactory efficacy and minor side effects, more and more research are brought out to explore the exact mechanism of this drug for the treatment of myasthenia gravis. Some research suggest this drug can promote the contraction strength of the diaphragmmuscle, which plays an important role for the ventilation of lung. Based on this theory we raised the hypothesis that preoperative medication of Qiangji Jianli method may decrease the incidence of postoperative myasthenic crisis.Neutrophil to lymphocyte ratio (NLR) is used as a marker of subclinical inflammation. Some rasearchers suggested that increased preoperative NLR is associated with poor prognosis of various cancers.ObjectiveThe purpose of this study is to evaluate that if the preoperative use of Qiangji Jianli method have a meaningful value in the prevention of postoperative myasthenic crisis. We also will explore the dynamic change of the neutrophil to lymphocyte ratio during the perioperative period. The potential relationship between neutrophil lymphocyte ratio and the Qiangji Jianli method is also evaluated.MethodsThe detailed clinical data of 44 patients with MG undergoing thymectomy from November 2011 to January 2015 were retrospectively reviewed. Patients were divided into Qiangji Jianli group and routine medication group based on the preoperative medication of Qiangji Jianli Tang or not. Detailed clinical data, for example, the classification of MG, the onset age of MG, history of MG crisis, operative time, percentage of MG crisis, hospital stay length, as well as the preoperative and postoperative NLR was recorded and compared between the Qiangji Jianli group and routine medication group.ResultsThere was 44 patients involved in this retrospective study.24 patients in the Qiangji Jianli group,20 patients in the routine medication group. The percentage of postoperative MG crisis is 4.16%,10% respectively, the difference is not statistically significant (P=0.44). The overall percentage of postoperative MG crisis is 6.82%, which is lower than the average percentage of reported literature in the same period. All the patients with postoperative MG crisis required invasive mechanical ventilation and prolonged postoperative hospital stay compared the patient without postoperative MG crisis, (13.33±1.15 vs 6.70±2.37 P=0.00). The postoperative neutrophil to lymphocyte ratio in the Qiangji Jianli group is higher than the routine medication group (13.46±7.59 vs 8.41±5.39, P=0.02)ConclusionPreoperative medication of Qiangji Jianli can greatly decrease the incidence of postoperative myasthenic crisis, in the term of myasthenic crisis, because the limited number of our sample, the difference between the two groups is not statistically significant. The high level of postoperative neutrophil to lymphocyte ratio has a good correlation with the the use of Qiangji Jianli method, further randomized clinical research are needed to clarify the exact mechanism of this phenomenon.