262例重症肌无力临床特征及相关因素回顾性分析
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摘要
目的:对262例重症肌无力(myasthenia gravis, MG)病例临床特征及相关因素进行回顾分析,为临床治疗提供参考。方法:收集2013年8月—2016年12月广州中医药大学第一附属医院确诊的262例MG患者病例资料,探讨患者发病诱因及复发加重因素、中医证型、西医分型与胸腺瘤的相关性及胸腺瘤与MG危象发生的关系。结果:MG以女性多见,男∶女=1∶1.45;可因感染、劳累、减药等诱因导致复发或病情加重,其中肺部感染最为常见。Osserman分型最多为Ⅱb型患者,共150例(57.25%);中医证型中脾胃气虚证所占比例最高,共141例(53.82%);Ⅲ型及IV型患者合并胸腺瘤比例明显高于另外两型患者;合并胸腺瘤患者危象发生率明显高于无胸腺瘤患者。结论:MG是因虚致损的疾病,脾胃虚损为其主要病机;临床以脾胃气虚证、脾虚湿热证及脾肾亏虚证为常见证型,胸腺瘤为其病程中逐渐形成的病理产物,胸腺瘤与MG的严重程度及危象的发生存在明显相关性,临症需标本兼顾。
Objective: Through retrospective analysis of 262 patients with myasthenia gravis(MG) to provide guidance for optimization of clinical treatment of MG. Methods: Totally 262 cases of MG diagnosed in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from August 2013 to December 2016 were collected,inducingrecurrence and aggravation factors, the correlation between TCM syndrome,the classification of Western medicine,MG crisis and thymoma were discussed. Results: MG was more common in women, male∶female=1∶1.45. Recurrence or aggravation can be caused by infection, fatigueand drug reduction, among which lung infection was the most common. The type Ⅱb was the most common in clinical classification of Osserman type, which were 150 cases(57.25%). MG with spleen Qi deficiency syndrome in hospitalized patients had the highest proportion, which were 141 cases(53.82%). The proportion of type Ⅲ and IV patients with thymoma were significantly higher than that of the other two types. Patients with thymoma had significantly higher incidence with MG crisis thanthose without thymoma. Conclusion: MG is a disease caused by deficiency whose main mechanism is spleen deficiency. Thymoma is pathological product gradually formed in the course, which is related to theseverity and the occurrence of MG crisis. The treatment needs to be taken into account both from manifestation and root cause of disease.
Objective: Through retrospective analysis of 262 patients with myasthenia gravis(MG) to provide guidance for optimization of clinical treatment of MG. Methods: Totally 262 cases of MG diagnosed in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from August 2013 to December 2016 were collected,inducingrecurrence and aggravation factors, the correlation between TCM syndrome,the classification of Western medicine,MG crisis and thymoma were discussed. Results: MG was more common in women, male∶female=1∶1.45. Recurrence or aggravation can be caused by infection, fatigueand drug reduction, among which lung infection was the most common. The type Ⅱb was the most common in clinical classification of Osserman type, which were 150 cases(57.25%). MG with spleen Qi deficiency syndrome in hospitalized patients had the highest proportion, which were 141 cases(53.82%). The proportion of type Ⅲ and IV patients with thymoma were significantly higher than that of the other two types. Patients with thymoma had significantly higher incidence with MG crisis thanthose without thymoma. Conclusion: MG is a disease caused by deficiency whose main mechanism is spleen deficiency. Thymoma is pathological product gradually formed in the course, which is related to theseverity and the occurrence of MG crisis. The treatment needs to be taken into account both from manifestation and root cause of disease.
引文
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[14] 徐升,刘友章,杨晓军.从脾胃论治重症肌无力[J].山东中医杂志,2006,25(11):727-728.
[15] 双晓萍,谭子虎.近30年重症肌无力中医证型和用药规律分析[J].辽宁中医药大学学报,2015,17(1):149-151.
[16] 吕安坤,孙红艳.中药治疗重症肌无力随机对照试验的Meta分析[J].世界科学技术-中医药现代化,2015,17(7):1492-1503.
[17] Okumura M,Ohta M,Tateyama H,et al.The World Health Organization histologic classificatetion system reflects the oncologic behavior of thymoma:a clinical study of 273 patients[J].Cancer,2002,94:624-632.
[18] 王中魁,黄旭升.伴胸腺瘤重症肌无力发病机制研究进展[J].中国神经免疫学和神经病学杂志,2017,24(2):139-142.
[19] 王莉莉,张运,贺茂林,等.伴其他自身免疫性疾病的重症肌无力临床特点分析[J].中国现代神经疾病杂志,2014,14(10):873-877.
[20] 李保华,伊伶,姜海平,等.伴胸腺瘤重症肌无力的临床特点(附96例分析)[J].中国神经精神疾病杂志,2000,26(3):143-144.
[2] Akaishi T,Suzuki Y,Imai T,et al.Response to treatment of myasthenia gravis according to clinical subtype[J].Bmc Neurology,2016,16(1):225.
[3] Romi F,Gilhus NE,Aarli JA.Myasthenia gravis:clinical,immunological,and therapeutic advances[J].Acta Neurologica Scandinavica,2010,111(2):134-141.
[4] 邓中光,邱仕君.邓铁涛对重症肌无力的认识与辨证论治[J].中国医药学报,1993,8(2):41-43.
[5] 黄子天,刘小斌.国医大师邓铁涛强肌健力饮治疗重症肌无力的临床应用及学术传承[J].广州中医药大学学报,2018(1):182-185.
[6] 陈灏珠.实用内科学[M].14版.北京:人民卫生出版社,2014:2490-2493.
[7] 许贤豪.神经免疫学[M].北京:北京医科大学·中国协和医科大学联合出版社,2001:100-165.
[8] 国家中医药管理局.中华人民共和国中医药行业标准-中医病证诊断疗效标准[S].北京:中国标准出版社,1994:92.
[9] 国家技术监督管理局.中华人民共和国国家标准中医临床诊疗术语—证候部分[S].北京:中国标准出版社,1997:47-78.
[10] 万顺伦,王炳旭,丛志强.老年期重症肌无力的临床特点[J].中华神经科杂志,1998(2):17-19.
[11] Hoedemaekers A,Graus Y,Vriesman PVB,et al.Age-and sex-related resistance to chronic experimental autoimmune myasthenia gravis (EAMG) in Brown Norway rats[J].Clinical & Experimental Immunology,2010,107(1):189-197.
[12] 邓铁涛,赵立诚,李贵芬.眼肌型重症肌无力的中医治疗与体会[J].新医药学杂志,1977(7):32-34.
[13] 阳涛,周欣欣,刘小斌.邓铁涛教授函诊治疗重症肌无力用药特点浅析[J].新中医,2011(4):134-135.
[14] 徐升,刘友章,杨晓军.从脾胃论治重症肌无力[J].山东中医杂志,2006,25(11):727-728.
[15] 双晓萍,谭子虎.近30年重症肌无力中医证型和用药规律分析[J].辽宁中医药大学学报,2015,17(1):149-151.
[16] 吕安坤,孙红艳.中药治疗重症肌无力随机对照试验的Meta分析[J].世界科学技术-中医药现代化,2015,17(7):1492-1503.
[17] Okumura M,Ohta M,Tateyama H,et al.The World Health Organization histologic classificatetion system reflects the oncologic behavior of thymoma:a clinical study of 273 patients[J].Cancer,2002,94:624-632.
[18] 王中魁,黄旭升.伴胸腺瘤重症肌无力发病机制研究进展[J].中国神经免疫学和神经病学杂志,2017,24(2):139-142.
[19] 王莉莉,张运,贺茂林,等.伴其他自身免疫性疾病的重症肌无力临床特点分析[J].中国现代神经疾病杂志,2014,14(10):873-877.
[20] 李保华,伊伶,姜海平,等.伴胸腺瘤重症肌无力的临床特点(附96例分析)[J].中国神经精神疾病杂志,2000,26(3):143-144.