摘要
Abstract
Objective To analyze the clinical manifestations and prognosis of patients with late-onset myasthenia gravis (LOMG).Methods Forty-five patients with LOMG undergoing treatment at Weifang People's Hospital,Qianfoshan Hospital of Shandong,and Xuanwu Hospital,Capital Medical University between January 2015 and January 2017 were selected as the study subjects.The patient general information,clinical symptoms,complications,laboratory tests,treatment,and follow-up data were collected and retrospectively analyzed.The clinical data of patients with different ages of onset and prognosis were compared.Results The 45 LOMG patients included 28 males and 17 females,with an average age of onset of (73.4±9.7) years.The initial symptoms included ocular muscle involvement 〔38 cases (84%)〕,ball palsy 〔31 cases (69%)〕,and difficulty raising the head 〔6 cases (13%)〕.According to the Osserman classification,there were 10 type Ⅰ,27 type Ⅱ, and 8 type Ⅲ early-stage cases,and 7 type Ⅰ,15 type Ⅱ,21 type Ⅲ and 2 type Ⅳ acme-stage cases.Eighteen patients (40%) had myasthenia gravis associated autoimmune dysfunction and 41 patients (91%) had at least one medical complication.Among the 43 patients who underwent AchR-Ab testing,39 (91%) were positive.Among the 33 patients who underwent cholinesterase inhibition testing,31 (94%) were positive.Abnormalities in neuromuscular electrophysiologic examinations existed in 20 (61%) of 33 patients.An increase in 1 or more autoantibodies occurred in 10 patients;there were 7 patients (17%) with abnormal thymus imaging among 42 patients who underwent chest imaging.Forty-two patients (93%) were treated with anti-cholinesterase inhibitors,36 patients (80%) received conventional immunosuppressive therapy,and 10 patients (22%) had thymectomies.The incidence of ball palsy,the Osserman classification in the early stage,and the mortality rate were significantly different among patients with different ages of onset (P<0.05).The Osserman classification in the acme-stage among patients who died was significantly higher than in survivors.The incidence of cancer and the number of hospitalizations during the follow-up period in the patients who died were also significantly higher than in survivors (P<0.05).Conclusion Patients with LOMG have clinical features,such as involvement of laryngeal muscles,diverse clinical manifestations,complications of autoimmune diseases,and poor response to thymectomy.Such patients should be followed closely with early diagnosis and treatment.关键词
重症肌无力/体征和症状/预后Key words
Myasthenia gravis/Signs and symptoms/Prognosis分类
医药卫生
