摘要
目的研究放疗联合胸腺瘤切除术治疗重症肌无力(MG)合并胸腺瘤患者的临床效果。方法选取2012年8月至2014年8月自贡市第四人民医院收治的122例MG合并胸腺瘤患者行胸腺瘤切除术的患者为研究对象,采用随机数字法将患者分为术后放化疗组和术后化疗组,每组61例。术后化疗组患者行胸腺瘤切除术联合化疗治疗,术后放化疗组在术后化疗组的基础上联合放射治疗。比较两组患者肌无力危象的发生情况、治疗后1个月和12个月的疗效以及不同时间点乙酰胆碱受体(AchR)、连接素(Titin)、兰尼碱受体(RyR)抗体水平。结果 MG合并胸腺瘤患者行胸腺瘤切除术后8例患者发生肌无力危象,占6.6%(8/122),其中术后放化疗组5例(8.2%),术后化疗组3例(4.9%),两组患者肌无力危象发生情况比较差异无统计学意义(P>0.05)。术后放化疗组治疗后1个月和12个月的有效率均显著高于术后化疗组[37.7%(23/61)比21.3%(13/61),82.0%(50/61)比42.6%(26/61),P<0.05],两组患者术后12个月的疗效高于术后1个月(P<0.05);术后化疗组患者AChR、Titin抗体的水平在不同时间点变化并不大,而术后放化疗组AChR、Titin的水平呈下降趋势,两组患者AChR、Titin抗体的水平在组间、时点间以及组间·时点间交互作用比较,差异均有统计学意义[AChR水平:(0.263±0.044)、(0.261±0.035)、(0.260±0.036)、(0.255±0.040)比(0.256±0.039)、(0.247±0.023)、(0.239±0.020)、(0.237±0.022);Titin:(0.193±0.023)、(0.192±0.023)、(0.191±0.021)、(0.191±0.024)比(0.191±0.019)、(0.188±0.017)、(0.185±0.014)、(0.155±0.007),P<0.05]。RyR抗体在组间、时点间以及组间·时点间交互作用比较,差异无统计学意义(P>0.05)。结论放疗联合胸腺瘤切除术治疗MG合并胸腺瘤可提高治疗效果,降低血清AChR、Titin抗体水平。
Objective To study the effect of radiotherapy combined with thymoma resection for treatment of patients with thymoma with myasthenia gravis（MG）. Methods Total of 122 patients with thymoma resection in gigong Fourth People＇s Hospital from Aug. 2012 to Aug. 2014 were included as the research objects. The patients were divided into a postoperative radiochemotherapy group and a postoperative chemotherapy group according to the random number method, 61 cases each. The postoperative chemotherapy group was given thymectomy treatment and chemotherapy, the postoperative radiochemotherapy group was added radiotherapy on the basis of the postoperative chemotherapy group. The myasthenic crisis, the curative effect after 1 month and 12 months of trreatment and the AChR,Titin,RyR antibody levels of the two groups at different time points were compared. Results After operation,8 （6. 6% ） patients had myasthenic crisis, 5 cases（ 8.2% ） from the postoperative radiochemotherapy group ,3 cases（4. 9% ） from the postoperative chemotherapy group,there was no statistically significant difference between the two groups（P 〉 0. 05）. The effective rates of 1 month and 12 months after treatment of the postoperative radiochemotherapy group were significantly higher than the postoperative chemotherapy group[37.7% （23/61） vs 21.3% （ 13/61 ） ,82. 0% （50/ 61 ） vs 42. 6% （26/61）, P 〈 0.05 ], and the difference was statistically significant （P 〈 0. 05 ）, the curative effect postoperative 12 months of both groups were higher than the postoperative 1 month（ P 〈 0. 05 ）. AChR and Titin antibody levels of the postoperative chemotherapy group at different time points did not change significantly, while the postoperative radiochemotherapy group were decreased, the AChR and Titin antibody levels between groups, different time points and groups·different time points were statistically significantly different[AChR：（0.263±0.044）,（0.261±0.035）,（260 ±0.036）,（0.255±0.040） vs （0.256
出处
《医学综述》
2016年第24期4989-4992,共4页
Medical Recapitulate
