摘要
目的探讨不同时机应用免疫抑制剂对成人重症肌无力电视胸腔镜手术效果的影响。方法回顾性分析2014年8月至2017年3月在秦皇岛市第一医院接受电视胸腔镜手术治疗的成人重症肌无力（myasthenia gravis，MG）患者的临床资料，根据其治疗方式分为对照组和观察组，对照组仅在术后给予免疫抑制剂治疗，观察组在术前和术后均给予免疫抑制剂治疗。观察两组患者术后恢复情况，比较两组患者治疗前后CD4^＋CD25^＋调节性T细胞（regular T ceHs，Tregs）百分率和乙酰胆碱受体抗体（acetyrlcholine receptor antibody，AchR．Ab）浓度、临床绝对评分和不良反应发生率的差异。结果观察组患者术后重症护理时间和术后住院时间均较对照组短（t=4．158、7．504，P〈0．05）；两组患者治疗前CD4^＋CD25^＋Tregs百分率和AchR—Ab浓度无差别，手术后3个月，观察组患者的CD4^＋CD25^＋Tregs百分率高于对照组（t=-8．653，P〈0．05），AchR-Ab水平低于对照组（t=6．604，P〈0．05）；两组患者治疗前临床绝对评分无差别，术后3个月，观察组临床绝对评分低于对照组（t=8．952，P〈0．05）；两组术后血压升高、血糖升高、肺部感染和肝肾功能异常发生率无明显差别（r=0．075，P=0．785）。结论治疗前后均给予免疫抑制剂治疗对成人MG电视胸腔镜手术效果有正性影响，具有良好的应用价值。
Objective To investigate the effect of immunosuppressive agents on video-assisted thoraco- scopic surgery for the treatment of adult myasthenia gravis. Methods The patient with adult myasthenia gravis who underwent video-assisted thoracoscopic surgery in Qinhuangdao first hospital from August 2014 to March 2017 were selected as the subjects. According to the treament, they were divided into two groups：the control group and the observation group. The control group received immunosuppressive therapy after operation, and the observation group was given immunosuppressive treatment before operation. The postoperative recovery of the two groups was observed. The difference of CD4＋ CD25＋ regular T cells（Tregs） percentage and AchR-Ab concentra- tion, clinical absolute score and adverse reaction rate between the two groups before and after treatment were compared. Results The postoperative critical care time and postoperative hospital stay in the observation group were shorter than those in the control group（ t = d. 158,7. 504, P 〈 0. 05） ;For the two groups of patients before operation, CD4 ＋ CD25 ＋ Tregs percentage and AchR-Ab concentration showed no difference. Three months after surgery, CD4＋ CD25 ＋ Tregs percentage in the observation gtroup was higher than those of the control group （t = - 8. 653 ,P 〈 0. 05）. AchR-Ab level is lower in the observation group than that in the control group （ t = 6. 604,P 〈 0. 05） ;There was no difference for clinical absolute score between the two groups. After 3 months, the clinical absolute score of the observation group was lower than that of the control group （ t = 8. 952, P 〈 0. 05 ）. There was no significant difference between the two for the groups in postoperative blood pressure eleva tion,blood glucose elevation, pulmonary infection, and the incidence of liver and kidney dysfunction （x^2 = 0. 075 ,P = 0. 785）. Conclusion Immunosuppressive therapy before and after operation has positive effect on adult myasthenia gravis treated with video-assisted thoracoscopic surgery. This treatment may have good applica- tion value.
作者
张舸
张哲峰
赵晓龙
薛雷
杜海荣
马丽娜
Zhang Ge, Zhang Zhefeng, Zhao Xiaolong, Xue Lei, Du Hairong, Ma LiMa(Department of Thoracic Surgery, Qinhuangdao First Hospital, Qinhuangdao 065000, Chia)
出处
《国际免疫学杂志》
CAS
2018年第1期23-26,共4页
International Journal of Immunology
关键词
免疫抑制剂
重症肌无力
胸腔镜
置管
Immunosuppressive agents
Myasthenia gravis
Thoracoscopy
Catheterization
