【摘要】 目的 本文旨在探讨老年人重症肌无力(MG)的临床特点。 方法 将本院12年间诊治的458例MG,根据发病年龄分为小儿组(≤14岁) 、成年组(15～59岁)及老年组(≥60岁)。回顾性分析各组病例的首发症状及其演变、合并症以及误诊情况,以明确老年MG患者的临床特点。 结果 老年组MG在整个MG人群中构成比小,男性发病者较多见,以延髓症状首发者多见,演变为呼吸困难者比例高,合并胸腺瘤者多而合并其他自体免疫病者少,以延髓症状首发而误诊为脑血管病者多见,病死率高,但死于肌无力危象者少,常死于多种并发症。 结论 掌握老年MG患者的临床特点有助于指导临床的诊断和治疗。
【关键词】 重症肌无力; 老年人; 临床研究
Clinical study of myasthenia gravis in elderly patients WANG Yahui,SU Zhenli. Department of Gerontology, Baoji Central Hospital, Baoji 721008,China
【Abstract】 Objective To study the clinical features of myasthenia gravis (MG) in elderly patients. Methods A total of 458 patients with MG were divided into three groups based on the onset age, which were juvenile group(≤14 years old), adult group (1559 years old) and aged group (≥60 years old). The differences of the clinical manifestations among the groups were analyzed. Results There were more male patients than female (M∶F=1.48∶1) in the aged group. The major presentation symptom was bulbospinal symptoms in the aged group. The incidence of bulbospinal symptoms evolving to dyspnoea was high. The incidence of the complication of thymoma in elderly patients was high, while the incidence of other autoimmune diseases was low. The mortality was higher in the aged group. Most elderly patients died from various complication. Conclusions The elderly MG patients has unique clinical features, which might help diagnose and treat MG in clinic.
【Key words】 myasthenia gravis; aged; clinical study
重症肌无力(MG)是乙酰胆碱受体介导的神经肌肉接头处传递障碍的自身免疫性疾病,临床特征为部分或全身骨骼肌易于疲劳,常在活动后加重,休息后减轻,具有晨轻暮重等特点。近来一些研究认为,老年人群MG的发病率较预期要高,临床症状与年轻人也有着明显的不同。上述原因加上老年人常见的疾病谱,给老年人MG的诊断造成了很大的困难。而且随着社会年龄结构的改变,老龄化人口的比例不断增加,有必要对老年发病的MG予以重视。
1 资料和方法
1.1 研究对象 MG患者均来自我院1997年12月至2009年12月12年间确诊MG患者。纳入标准:根据典型的临床表现,疲劳试验及新斯的明试验阳性为诊断依据,其中的部分患者通过神经低频重复电刺激检查和血清乙酰胆碱受体抗体测定而进一步佐证MG的诊断。全部病例均符合1997年全国神经免疫学术会议讨论,许贤豪[1]整理的MG诊断标准。共458例,其中男216例,女242例,患者发病年龄从2月到86岁。根据发病年龄分为3组:小儿组162例,男73例,女89例,年龄≤14岁,男性平均(7.0±6.8)岁、
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