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目的比较胸腺切除与药物治疗对儿童型重症肌无力(myasthenia gravis,MG)的疗效。方法随访38例行胸腺扩大切除术及45例经药物治疗的5～14岁MG患儿的治疗效果。在接受手术/药物治疗前、治疗后3周、治疗后1年3个时间点检测MG患儿外周血淋巴细胞亚群比例。结果手术组完全缓解率(1年:47.4%vs.20.0%;2年:55.3%vs.22.2%)和总有效率(1年:71.1%vs.48.9%;2年:81.6%vs.55.5%)明显优于药物治疗组,差异有统计学意义(P﹤0.05);手术组第2年无效率显著降低,差异有统计学意义(P﹤0.05);两组恶化率的差异无统计学意义。与正常对照组比较,MG患儿治疗前外周血CD8+T细胞百分比显著降低,外周血CD4+/CD8+显著升高,差异有统计学意义(P﹤0.05)。手术组1年后CD4+/CD8+较治疗前明显下降,差异有统计学意义(P﹤0.05)。结论胸腺切除治疗儿童型MG能够提高临床缓解率,改善患儿预后。
Objective To compare the therapeutic effect of thymectomy and drug therapy on myasthenia gravis (MG). Methods Thirty-eight patients undergoing thymectomy and 45 patients with MG aged 5-14 years were followed up. The proportion of peripheral blood lymphocyte subsets in children with MG was measured before surgery / drug treatment, 3 weeks after treatment and 1 year after treatment. Results The complete remission rate (1 year: 47.4% vs. 20.0%; 2 years: 55.3% vs.22.2%) and total effective rate (1 year: 71.1% vs.48.9%; 2 years: 81.6% vs.55.5 %) Was significantly better than the drug treatment group, the difference was statistically significant (P <0.05); the second year of operation group was significantly lower inefficiency, the difference was statistically significant (P <0.05); the difference between the two groups was not statistically significant significance. Compared with the normal control group, the percentage of CD8 + T cells in peripheral blood and the level of CD4 + / CD8 + in peripheral blood were significantly increased in MG children before treatment (P <0.05). The level of CD4 + / CD8 + in the operation group after 1 year was significantly lower than that before the treatment, the difference was statistically significant (P <0.05). Conclusion Thymectomy for children with MG can improve the clinical remission rate and improve the prognosis of children.