| Background and purpose: Myasthenia gravis(MG)is an autoimmune disease mediated by the acetylcholine receptor(AChR)antibody or functional related molecular antibody,which can reduce the AChR in the nerve-muscle junction and cause the transmission dysfunction between the nerve-muscle junction.It has been confirmed that the pathogenesis of MG is related to the thymic gland.Thymectomy has become an important treatment for MG with thymic hyperplasia or thymoma.However,the most serious complication of postoperative MG is myasthenia crisis(MC),and the mortality rate was higher.In this study,we collected and analyzed the clinical data of MG patients who underwent thymectomy in our hospital,and discussed the risk factors that may lead to postoperative MC and the factors that affect the long-term effect.The purpose of this study is to provide evidence for guiding the perioperative management of MG and improving the long-term prognosis.It is helpful for medical staff to design intervention measures for effective control and reasonable and active preoperative preparation,and reduce the incidence of postoperative MC.Objects and Methods: Through the medical record inquiry system,the clinical data of 47 MG patients who were admitted to the first affiliated hospital of guangxi medical university from January 2008 to January 2018 and were successfully followed up by telephone after the operation were retrospectively collected.Collect respondents whether general demographic characteristics,course,along with other autoimmune diseases,preoperative bromine overlooks the dosage of Ming,is operable immunosuppressive drugs,surgical procedure,thymus and postoperative pathological type whether in myasthenia crisis,etc.,analyzed the related risk factors for postoperative MC and the long-term curative effect of related factors.Results: 1.In this study,the incidence rate of postoperative MC was 29.79%.2.Univariate analysis showed that there was no significant difference in sex,age,course of disease,dosage of pyridostigmine before operation,pathological type of thymus and combination of immunosuppressive drugs with or without immunosuppressive drugs(P > 0 05).Preoperative modified Osserman classification,accompanied by other autoimmunity sexual disease and mode of operation were the related factors of postoperative MC(P < 0 05).3.Multivariate Logistic regression analysis showed that other autoimmune diseases(OR,0.051;95%CI 0.0030.792)and thoracoscopic surgery(OR,8.236;95%CI 1.086-62.480)were independent risk factors for postoperative MC.Preoperative modified Osserman classification is a related factor in the occurrence of postoperative MC,of which type IIb and type III are the higher.4.In this study,the composition of postoperative long-term treatment intensity was 0 grade(53.18%),grade 1(12.77%),grade 2(10.64%),grade 3(12.77%)and death(10.64%).In the death group,the long-term effect was as follows: remission group(85.71%)and unremission group(14.29%).5.The Chi-square test of long-term effect showed that there were significant differences in the long-term effect among the modified Osserman classification,other autoimmune diseases and the dosage of bromopyrazole before operation(P < 0 05),among which type IIb accounted for a large proportion in the non-remission group,and there were significant differences in the long-term effect between the two groups(P < 0.05).The prognosis of type IIb was slightly worse than that of other types.Multivariate Logistic regression analysis did not confirm that the three were independent risk factors.Conclusion: 1.Accompanied by other autoimmune diseases is an independent risk factor of postoperative MC,and patients with other autoimmune diseases are more prone to postoperative myasthenic crisis.Preoperative examination suggested that patients with other autoimmune diseases should be more vigilant to prevent postoperative MC.2.Different preoperative modified Osserman typing can affect the occurrence of postoperative MC,among which the incidence of postoperative MC of type IIb is relatively high.For systemic MG patients,preoperative control of the clinical classification of MG to mild may have a positive effect on reducing the incidence of postoperative MC.3.The long-term remission group of postoperative patients accounted for the vast majority(85.71%),indicating that the overall long-term prognosis of thymectomy for MG patients with thymus abnormalities was good.Therefore,early thymectomy was recommended for patients with thymus abnormalities.4.Preoperative modified Osserman typing,the presence or absence of other autoimmune diseases,and preoperative dosage of bromopyrimide are related factors for long-term efficacy,but not independent risk factors.In the later stage,the sample size still needs to be expanded for further analysis. |
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