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目的探讨眼肌型重症肌无力的临床特点及治疗。方法对1998年7月至2005年7月我院收治的84例眼肌型重症肌无力患者的临床表现、实验室检查、胸腺计算机断层扫描(CT)检查及治疗资料进行回顾性分析。结果本组患者发病年龄2.5~70岁。全部患者均有上睑下垂。其中35.7%伴有复视;25%伴有显性斜视。1例伴有眼内肌异常;1例出现视物模糊。血清AchR抗体检查阳性率27.6%,胸腺CT检查异常率64.3%。溴化吡啶斯的明(单纯3-二甲胺基甲酰氧基-1-甲基吡啶溴化物)口服治疗组治愈率48.1%;大剂量甲基强的松龙冲击治疗组治愈率66.7%;胸腺切除手术组治愈率51.9%。结论眼肌型重症肌无力患者以提上睑肌受累多见,也可有其它眼肌的受累;治疗应结合病情,可给予胆碱脂酶抑制剂、大剂量甲基强的松龙冲击及胸腺切除手术,治疗效果显著。
Objective To investigate the clinical features and treatment of ocular myasthenia gravis. Methods The clinical manifestations, laboratory tests, thymus computed tomography (CT) examination and treatment data of 84 patients with myasthenia gravis admitted to our hospital from July 1998 to July 2005 were analyzed retrospectively. Results The incidence of this group of patients aged 2.5 to 70 years. All patients had ptosis. 35.7% with diplopia; 25% with dominant strabismus. One patient had abnormal intraocular muscles and one patient had blurred vision. Serum AchR antibody test positive rate of 27.6%, thymus CT abnormal rate of 64.3%. The cure rate was 48.1% in the oral treatment group with pyridostigmine bromide (pure 3-dimethylaminocarbonyl-1-methylpyridinium bromide); the cure rate in the high-dose methylprednisolone impact treatment group was 66.7% The cure rate of thymectomy group was 51.9%. Conclusions Patients with ocular myasthenia gravis are more common in upper levator muscle and may have other oculomotor involvement. Treatment should be combined with the disease, may be given cholinesterase inhibitors, high-dose methylprednisolone impact and Thymectomy surgery, the treatment effect is remarkable.