Clinical Analysis Of 131 Cases Of Myasthenia Gravis In Hainan Island

Objective: Myasthenia gravis is an autoimmune disease caused by impaired acetylcholine antibodiesleading to neuro-muscular junction transmission dysfunction.With the continuous study of myasthenia gravis epidemiology,pathogenesis,clinical manifestations,treatment and other issues,great progress has been made.however,the epidemiological reports of myasthenia gravis vary from country to country,the pathogenesis is not completely clear,its clinical manifestations are complex and diverse,often lead to misdiagnosis or missed diagnosis.The clinical data of myasthenia gravis in Hainan are not reported yet.therefore,this study retrospectively analyzed the clinical characteristics of myasthenia gravis patients in Hainan,in order to provide the basis for clinical decision-making and bring more benefits to patients.Methods: The data of patients with myasthenia gravis diagnosed in the affiliat ed hospital of Hainan medical college from January 2012 to December 2016 were collected.the gender,age,initial symptoms,etiology,auxiliary examinatio n,complications,treatment methods,efficacy and prognosis were analyzed retros pectively.Results:In this study,all patients with myasthenia gravis were local residents of Hainan Island,basically including all cities and counties,with a representative area,of which 39(29.77%)were from Haikou City.Among them,there were 77 cases in the northern part of Hainan Island and 54 cases in the southern part.There were 66 male patients(50.38%),65 female patients(49.62%),and male: female = 1:0.98.The youngest age of onset was November and the largest was 84 years old.Seven types of first symptoms were found in this study: diplopia,ptosis of both eyes,monocular ptosis,drooping eyelids and diplopia,weakness of limbs,poor articulation,difficulty in swallowing.76.34% of patients had first symptoms of extraocular muscle involvement,including 22.90% with binocular ptosis,43.51% with monocular ptosis,and 6.11% with diplopia,3.81% with monocular ptosis and diplopia,the second was weakness of limbs(13.74)and dysphagia(8.40%),the most rare of which was dysarthria(1.53%).The clinical classification of MG patients in this study was 13 children(9.92%)in children,7(5.34%)in adolescents.In adult Osserman classification,there were 39(29.77%)cases with type I and 19 cases(14.50%)with type IIA,39 cases(29.77%)of type IIB,5 ca ses of type III(3.85%),8 cases(6.11%)of type IV,1 cases(0.76%)of type V.The positive rate of neostigmine was 98.00% in 100 patients.84 ofpatients were examined with repetitive nerve stimulation(RNS),The positive rate of III type RNS was as high as 100%,followed by adults with type IIB,with 82.61%,with the lowest positive rate of type I in adults(41.38%).There were 73 cases(55.72%)with thymic abnormalities,including 45 cases with thymoma,17 cases with thymic hyperplasia and 11 cases with suspicious thymic lesions.among them,the young patients were more likely to be associated with thymic abnormalities(43.84%).In this study,85 cases were examined for thyroid function,the positive rate was 37.65%.The majority of MG patients with abnormal thyroid biochemical indexes were adolescents,and the positive rate was 75%.In the treatment of internal medicine,the effective rate of treatment in juvenile type III patients was as high as 100,followed by IIA type 93.33%,the best therapeutic effect in juvenile group was 100%,followed by young group(93.94%),and the aged group was the worst treatment effect(60.00%).Among the 97 follow-up patients,the prognosis of children type mg was better(92.31%),and that of adult type I patients was worse(66.67 %).Conclusion:The incidence rate of myasthenia gravis in Hainan Island is basically the same between men and women.patients aged 31 ~ 50 years old are the most common.the clinical manifestations are complex and varied.55.72 % of mg patients with thymic abnormalities and 37.65 % of mg patients with thyroid dysfunction.clinical screening should be strengthened to detect problems as soon as possible.According to the individual situation of the patients,reasonable treatment plan was made.the prognosis of children type mg patients was the best.the prognosis of adult type I patients was poor,and it was easier to progress to systemic type.