胸腺切除治疗非胸腺瘤重症肌无力的研究进展
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摘要
重症肌无力(MG)是一种累及神经肌肉接头的自身免疫性疾病,以骨骼肌的病态疲劳为主要特点,其发病与胸腺病变如胸腺瘤、胸腺肥大、淋巴滤泡增生及胸腺萎缩密切相关。MG的治疗包括应用胆碱酯酶抑制剂、免疫抑制剂、免疫球蛋白、血浆置换及胸腺切除术,胸腺切除术治疗合并胸腺瘤的MG患者效果确切。近年来有学者报道可应用胸腺切除术治疗非胸腺瘤MG患者,但其治疗价值目前还存在争议。本文就胸腺切除术治疗非胸腺瘤MG的研究进展进行综述。
Myasthenia gravis(MG) is an autoimmune disease involving neuromuscular junction, taking pathological fatigue of skeletal muscle as main characteristics, its pathogenesis is closely related to thymic lesion, such as thymoma,megalothymus, lymphoblastic follicular hyperplasia, and thymic atrophy. The treatment of MG includes application of cholinesterase inhibitors, immunosuppressor, immune globulin, plasmapheresis and thymectomy, the effect of thymectomy in the treatment of MG patients combined with thymoma is exact. In recent years, some scholars have reported that thymotomy can be used to treat MG patients with non-thymoma, but its therapeutic value is controversial at present.This paper reviews the research progress of thymectomy in the treatment of non-thymomatous MG.
Myasthenia gravis(MG) is an autoimmune disease involving neuromuscular junction, taking pathological fatigue of skeletal muscle as main characteristics, its pathogenesis is closely related to thymic lesion, such as thymoma,megalothymus, lymphoblastic follicular hyperplasia, and thymic atrophy. The treatment of MG includes application of cholinesterase inhibitors, immunosuppressor, immune globulin, plasmapheresis and thymectomy, the effect of thymectomy in the treatment of MG patients combined with thymoma is exact. In recent years, some scholars have reported that thymotomy can be used to treat MG patients with non-thymoma, but its therapeutic value is controversial at present.This paper reviews the research progress of thymectomy in the treatment of non-thymomatous MG.
引文
[1]中华医学会神经病学分会神经免疫学组.中国重症肌无力诊断和治疗指南2015[J].中华神经科杂志,2015,48(11):934-940.
[2]Barnett C,Katzberg HD,Keshavjee S,et al.Thymectomy for non-thymomatous myasthenia gravis:a propensity score matched study[J].Orphanet J Rare Dis,2014,9(1):1-8.
[3]Levinson AI.Modeling the intrathymic pathogenesis of myasthenia gravis[J].J Neurol Sci,2013,333(1/2):60-67.
[4]Cavalcante P,Cufi P,Mantegazza R,et al.Etiology of myasthenia gravis:Innate immunity signature in pathological thymus[J].Autoimmun Rev,2013,12(9):863-874.
[5]Nikolic A,Djukic P,Basta I,et al.The predictive value of the presence of different antibodies and thymus pathology to the clinical outcome in patients with generalized myasthenia gravis[J].Clin Neurol Neurosurg,2013,115(4):432-437.
[6]Cavalcante P,Le Panse R,Berrih-Aknin S,et al.The thymus in myasthenia gravis:Site of“innate autoimmunity”?[J]Muscle Nerve,2011,44(4):467-484.
[7]Ruffini E,Guerrera F,Filosso PL,et al.Extended transcervical thymectomy with partial upper sternotomy:results in non-thymomatous patients with myasthenia gravis[J].Eur J Cardiothorac Surg,2014,48(3):448-454.
[8]De Roxas RC,Bagnas MA,Baldonado JJ,et al.Clinical Profile and Outcome of Postthymectomy versus NonThymectomy Myasthenia Gravis Patients in the Philippine General Hospital:A 6-Year Retrospective Study[J].Front Neurol,2016,7(10):96.
[9]Cea G,Benatar M,Verdugo RJ,et al.Thymectomy for nonthymomatous myasthenia gravis[J].Cochrane Database Syst Rev,2013,10(10):CD008111.
[10]Melzer N,Ruck T,Fuhr P,et al.Clinical features,pathogenesis,and treatment of myasthenia gravis:a supplement to the Guidelines of the German Neurological Society[J].J Neurol,2016,263(8):1473-1494.
[11]Matsumoto MY,Matsuo H,Oka T,et al.Thymic myoid cells as a myasthenogenic antigen and antigen-presenting cells[J].J Neuroimmunol,2004,150(1/2):80-87.
[12]Wolfe GI,Milinis K,Aban IB,et al.Randomized Trial of Thymectomy in Myasthenia Gravis[J].N Engl J Med,2016,375(6):511.
[13]Tzankov A.Commentary on“Randomized trial of thymectomy in myasthenia gravis”[J].J Thorac Dis,2016,8(10):E1420-E1422.
[14]Blalock A,Harvey AM,Ford FR,et al.THE TREAT-MENT OF MYASTHENIA GRAVIS BY REMOVAL OFTHE THYMUS GLAND:PRELIMINARY REPORT[J].JAm Med Assoc,1941,117(18):1529-1533.
[15]Luo Y,Pan DJ,Chen FF,et al.Effectiveness of thymectomy in non-thymomatous myasthenia gravis:a systematic review[J].J Huazhong Univ Sci Technol Med Sci,2014,34(6):942-949.
[16]Zhu K,Li J,Huang X,et al.Thymectomy is a beneficial therapy for patients with non-thymomatous ocular myasthenia gravis:a systematic review and meta-analysis[J].Neurol Sci,2017,38(10):1-8.
[17]Ware TL,Ryan MM,Kornberg AJ.Autoimmune myasthenia gravis,immunotherapy and thymectomy in children[J].Neuromuscul Disord,2012,22(2):118-121.
[18]Sanders DB,Wolfe GI,Benatar M,et al.International consensus guidance for management of myasthenia gravis[J].Neurology,2016,87(4):419-425.
[19]Raza A,Woo E.Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis[J].Annals of Cardiothoracic Surgery,2016,5(1):33.
[20]Lo CM,Lu HI,Hsieh MJ,et al.Thymectomy for myasthenia gravis:video-assisted versus transsternal[J].JFormos Med Assoc,2014,113(10):722-726.
[21]罗国军,庄江能,李卓东,等.胸腺瘤不同外科手术治疗方式的临床对比研究[J].中华全科医学,2012,10(4):531-531.
[22]俞晖.电视胸腔镜下手术治疗胸腺瘤与传统手术治疗的临床对比研究[J].临床和实验医学杂志,2014,13(19):1615-1618.
[23]Lin MW,Chang YL,Huang PM,et al.Thymectomy for non-thymomatous myasthenia gravis:a comparison of surgical methods and analysis of prognostic factors[J].Eur J Cardiothorac Surg,2010,37(1):7-12.
[24]宋阳,伍宁,陈刚,等.电视胸腔镜与经胸骨手术治疗重症肌无力伴胸腺瘤的临床对比研究[J].中国临床神经科学,2016,24(2):179-185.
[25]Friedant AJ,Handorf EA,Su S,et al.Minimally Invasive versus Open Thymectomy for Thymic Malignancies:Systematic Review and Meta-Analysis[J].J Thorac Oncol,2016,11(1):30-38.
[26]Gung Y,Zhang H,Li S,et al.Sternotomy versus video‐assisted thoracoscopic surgery for thymectomy of myasthenia gravis patients:A meta‐analysis[J].Asian J Endosc Surg,2016,9(4):285-294.
[2]Barnett C,Katzberg HD,Keshavjee S,et al.Thymectomy for non-thymomatous myasthenia gravis:a propensity score matched study[J].Orphanet J Rare Dis,2014,9(1):1-8.
[3]Levinson AI.Modeling the intrathymic pathogenesis of myasthenia gravis[J].J Neurol Sci,2013,333(1/2):60-67.
[4]Cavalcante P,Cufi P,Mantegazza R,et al.Etiology of myasthenia gravis:Innate immunity signature in pathological thymus[J].Autoimmun Rev,2013,12(9):863-874.
[5]Nikolic A,Djukic P,Basta I,et al.The predictive value of the presence of different antibodies and thymus pathology to the clinical outcome in patients with generalized myasthenia gravis[J].Clin Neurol Neurosurg,2013,115(4):432-437.
[6]Cavalcante P,Le Panse R,Berrih-Aknin S,et al.The thymus in myasthenia gravis:Site of“innate autoimmunity”?[J]Muscle Nerve,2011,44(4):467-484.
[7]Ruffini E,Guerrera F,Filosso PL,et al.Extended transcervical thymectomy with partial upper sternotomy:results in non-thymomatous patients with myasthenia gravis[J].Eur J Cardiothorac Surg,2014,48(3):448-454.
[8]De Roxas RC,Bagnas MA,Baldonado JJ,et al.Clinical Profile and Outcome of Postthymectomy versus NonThymectomy Myasthenia Gravis Patients in the Philippine General Hospital:A 6-Year Retrospective Study[J].Front Neurol,2016,7(10):96.
[9]Cea G,Benatar M,Verdugo RJ,et al.Thymectomy for nonthymomatous myasthenia gravis[J].Cochrane Database Syst Rev,2013,10(10):CD008111.
[10]Melzer N,Ruck T,Fuhr P,et al.Clinical features,pathogenesis,and treatment of myasthenia gravis:a supplement to the Guidelines of the German Neurological Society[J].J Neurol,2016,263(8):1473-1494.
[11]Matsumoto MY,Matsuo H,Oka T,et al.Thymic myoid cells as a myasthenogenic antigen and antigen-presenting cells[J].J Neuroimmunol,2004,150(1/2):80-87.
[12]Wolfe GI,Milinis K,Aban IB,et al.Randomized Trial of Thymectomy in Myasthenia Gravis[J].N Engl J Med,2016,375(6):511.
[13]Tzankov A.Commentary on“Randomized trial of thymectomy in myasthenia gravis”[J].J Thorac Dis,2016,8(10):E1420-E1422.
[14]Blalock A,Harvey AM,Ford FR,et al.THE TREAT-MENT OF MYASTHENIA GRAVIS BY REMOVAL OFTHE THYMUS GLAND:PRELIMINARY REPORT[J].JAm Med Assoc,1941,117(18):1529-1533.
[15]Luo Y,Pan DJ,Chen FF,et al.Effectiveness of thymectomy in non-thymomatous myasthenia gravis:a systematic review[J].J Huazhong Univ Sci Technol Med Sci,2014,34(6):942-949.
[16]Zhu K,Li J,Huang X,et al.Thymectomy is a beneficial therapy for patients with non-thymomatous ocular myasthenia gravis:a systematic review and meta-analysis[J].Neurol Sci,2017,38(10):1-8.
[17]Ware TL,Ryan MM,Kornberg AJ.Autoimmune myasthenia gravis,immunotherapy and thymectomy in children[J].Neuromuscul Disord,2012,22(2):118-121.
[18]Sanders DB,Wolfe GI,Benatar M,et al.International consensus guidance for management of myasthenia gravis[J].Neurology,2016,87(4):419-425.
[19]Raza A,Woo E.Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis[J].Annals of Cardiothoracic Surgery,2016,5(1):33.
[20]Lo CM,Lu HI,Hsieh MJ,et al.Thymectomy for myasthenia gravis:video-assisted versus transsternal[J].JFormos Med Assoc,2014,113(10):722-726.
[21]罗国军,庄江能,李卓东,等.胸腺瘤不同外科手术治疗方式的临床对比研究[J].中华全科医学,2012,10(4):531-531.
[22]俞晖.电视胸腔镜下手术治疗胸腺瘤与传统手术治疗的临床对比研究[J].临床和实验医学杂志,2014,13(19):1615-1618.
[23]Lin MW,Chang YL,Huang PM,et al.Thymectomy for non-thymomatous myasthenia gravis:a comparison of surgical methods and analysis of prognostic factors[J].Eur J Cardiothorac Surg,2010,37(1):7-12.
[24]宋阳,伍宁,陈刚,等.电视胸腔镜与经胸骨手术治疗重症肌无力伴胸腺瘤的临床对比研究[J].中国临床神经科学,2016,24(2):179-185.
[25]Friedant AJ,Handorf EA,Su S,et al.Minimally Invasive versus Open Thymectomy for Thymic Malignancies:Systematic Review and Meta-Analysis[J].J Thorac Oncol,2016,11(1):30-38.
[26]Gung Y,Zhang H,Li S,et al.Sternotomy versus video‐assisted thoracoscopic surgery for thymectomy of myasthenia gravis patients:A meta‐analysis[J].Asian J Endosc Surg,2016,9(4):285-294.