ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG CỦA NGƯỜI BỆNH NHƯỢC CƠ CÓ PHẪU THUẬT TUYẾN ỨC

Abstract

Background: Myasthenia gravis (MG) is mainly caused by autoantibodies attacking acetylcholine receptors (AChRs), which are thought to originate from germinal centers of the thymus. Methods: We conducted a retrospective descriptive study on 60 MG patients aged ≥18 who underwent thymectomy and had tissue histopathology reports at the University of Medicine and Pharmacy Hospital in Ho Chi Minh City from January 2017 to January 2022. Results: In our sample, 32 patients had thymomatous MG (ThMG) and 28 patients had non -thymomatous MG. 41 patients had early-onset myasthenia gravis (EOMG) and 19 patients had late-onset myasthenia gravis (LOMG). 93.4% of patients were classified as MGFA class I, II at admission, while all patients were classified as MGFA class I, II after hospital discharge. The AChR-Ab concentration did not differ between the ThMG group and non-ThMG group. Among the ThMG group, the thymic tissue WHO pathology classifications were type AB (25%), A (3.1%), B1 and B2 (46.8%), B3 (6.3%). On the other hand, the non-ThMG group primarily consisted of thymic hyperplasia (35.7%) and thymic remnants (50%). The accuracy rate of thoracic MRI and CT Scan in identifying thymic lesions consistent with pathological results were  95.2% and 84.6%, respectively. The need for corticoide and pyridostigmin decreased at 12 months after thymectomy (p=0.049, p=0.003, respectively). The rates of patients who had symptoms remission after 6 and 12 months were higher than the rate at hospital discharge (p<0.001). No significant difference in the clinical outcome was found between ThMG and non-ThMG at 12 months after thymectomy (p=0.48). Conclusion: Post-thymectomy can reduce MG patients’ need for medications and the severity of MG after 12 months.