Clinical Analysis Of 101 Cases Of Ocular Myasthenia Gravis

Objectives: Based on the analysis of clinical data of 101 patients with Myasthenia Gravis(MG)whose first symptom is simple ocular muscle involvement,this paper summarizes the epidemiological and clinical characteristics of the patients with Ocular Myasthenia Gravis(OMG),and discusses the influence of OMG on generalized myasthenia gravis(GMG)transformation of risk factors and protective factors,so as to predict the changes of patients with OMG and to develop individualized treatment plan.Methods: From January 2014 to December 2019,101 cases of MG patients with simple ocular muscle involvement as the first symptom were collected from the Department of Neurology,The second hospital of Dalian medical university.The patients' gender,age of onset,predisposing factors,onset of ophthalmic symptoms(ptosis,diplopia,ptosis with diplopia),onset side(unilateral,bilateral),previous history(smoking history,drinking history,hypertension,diabetes),thyroid disease,rheumatic immune disease,chest CT(normal,thymic hyperplasia,thymoma),thymectomy operation,time from onset to operation,pathological type of thymoma,anti acetylcholine receptor antibody(ACh R-Ab),muscle specific tyrosine kinase antibody(Mu SK-Ab),anti linker antibody Antibodies(Titin-Ab),anti myocardial antibody,anti skeletal muscle antibody,repetitive nerve electrical stimulation(RNS),initial drug(bromopyrimidine,hormone and / or tacrolimus),complete stable release relapse(CSR-RMG)and minimal residual symptom status relapse,(MMS-RMG),whether there is conversion,conversion time and so on were used as variables.At the end of follow-up,whether the OMG was converted into GMG or not was used as dependent variable.The patients were divided into two groups: the group still suffering from ophthalmic muscle injury(OMG-R)and the group secondary suffering from systemicskeletal muscle injury(SGMG).The statistical software spss 23.0 was used to analyze the data,and the test level was p < 0.05.Results: 1.There was no difference in the sex ratio between men and women in the patients with OMG.The age of onset was more than 50 years old,and there was no significant peak in the age of onset.In OMG patients,there was no difference in the side of the eye muscle.Ptosis was the most common symptom of the eye muscle.About58% of the patients had thymus abnormality(thymus hyperplasia 43%,thymoma 15%),32% of the patients had thyroid disease,43% of the patients had RNS abnormality.The conversion rate of SGMG was 48.1% in one year,66.7% in two years and 85.2% in five years.2.There was no significant difference between OMG-R group and SGMG group in gender,onset age,previous history(smoking,drinking,hypertension,diabetes),onset of ophthalmic symptoms(P > 0.05).3.There was no significant difference between OMG-R group and SGMG group in rheumatic immune disease,thymectomy,CSR-RMG and MMS-RMG(P > 0.05).4.Compared with OMG-R group,SGMG group had more onset of unilateral ophthalmopathy(63% vs 36%),multiple non pathogenic factors(83% vs 17%),more complications of thyroid disease(39% vs 23%),more thymus hyperplasia(56% vs29%),more thymoma(18% vs 11%),longer operation time from onset to thymoma(7.375 ± 2.83 M vs 2 ± 1.41M),more abnormal RNS(86% vs 46%),more non facial nerve abnormalities in RNS(52% vs 11%)The difference was statistically significant(P < 0.05).5.Single factor Logistic regression analysis showed that unilateral ophthalmic myopathy(OR = 3.000,P = 0.008),no predisposing factor(OR = 4.038,P = 0.003),thyroid disease(OR = 2.864,P = 0.029),thymic hyperplasia(OR= 4.473,P = 0.002)or thymoma(OR = 3.738,P = 0.043),RNS abnormality(OR= 7.262,P = 0.002),immunotherapy(hormone and / or tacrolimus)(OR= 0.193,P = 0.016))It was a predictor of the transformation from OMG to GMG(P < 0.05).However,there was nocorrelation between sex,age of onset,ophthalmic symptoms,smoking,diabetes mellitus,rheumatic and immune diseases,non facial nerve abnormality of RNS and the transformation from OMG to GMG(P > 0.05).6.By multivariate logistic regression analysis,thyroid disease(OR= 6.243,P =0.034),thymic hyperplasia(OR = 5.898,P = 0.020),RNS abnormality(OR= 9.944,P =0.009)were independent predictors of OMG to GMG transformation(P < 0.05).Conclusions: 1.OMG patients with unilateral ophthalmopathy,no inducement,abnormal RNS,thyroid disease,thymoma or thymus hyperplasia are more likely to convert to GMG,and the conversion rate is positively correlated with the course of disease.2.RNS abnormality,thyroid disease and thymus hyperplasia are independent risk factors for the transformation of OMG to GMG.Immunotherapy(hormone and / or tacrolimus)is the protective factor.