Comparative Analysis Of Clinical Characteristics And Curative Effect Between Early-onset And Late-onset Myasthenia Gravis

ObjectiveThe objective of this study is to describe the characteristics of patients with early-onset myasthenia gravis(early-onset myasthenia gravis,EOMG)and late-onset myasthenia gravis(late-onset myasthenia gravis,LOMG).And another aim is to comparative the different of curative effect between the two groups of patients treated with hormone alone or hormone combined with gamma globulin.MethodsThe clinical data of 153 cases of myasthenia gravis(myasthenia gravis,MG)diagnosed in the department of neurology of our hospital from June 2012 to February2021 were analyzed retrospectively.According to the age of onset,they were divided into EOMG group(onset age < 50 years old)and LOMG group(onset age ≥ 50 years old).The clinical characteristics of the two groups were summarized.According to whether the treatment was combined with immunoglobulin therapy,the patients were divided into two subgroups: hormone group and hormone combined therapy group((combined use of gamma globulin on the basis of glucocorticoid application).In order to comparative the different of curative effect between the two groups,some parameters were compared,including clinical absolute score,effective rate,rehospitalization rate,average length of stay and so on.Results1.A total of 153 patients with MG were included in this study.Including87 patients with EOMG and 66 patients with LOMG.The male-to-female ratio of EOMG patients is 1:1.29 and the male-to-female ratio of LOMG patients is1:1.28.There was no significant gender difference between EOMG and LOMG groups(P>0.05).The weakness of extraocular muscles is the first symptom of EOMG and LOMG,and the main clinical classification is type IIb.The possibility of generalization is higher in patients with LOMG(P=0.034).There were 46 cases(52.9%)with abnormal thymus in EOMG group and 30 cases(45.5%)with abnormal thymus in LOMG.The incidence of thymic hyperplasia in EOMG group was higher than that in LOMG group(P=0.024).There was no significant difference in serological antibody,EMG and neostigmine test between EOMG group and LOMG group(P>0.05).2.Hormone therapy was still the first choice in both EOMG group and LOMG group.94.3% of patients in EOMG group received hormone therapy,and 90.9% of patients in LOMG group received hormone therapy.The proportion of hormone combined with gamma globulin in EOMG group was higher than that in LOMG group,but there was no significant difference between the two groups(P=0.579).The total effective rate of EOMG group was85.1%.The total effective rate of focus LOMG group was 86.4%.There was no significant difference between the two groups(P>0.05).In different hormone dosage subgroups,the effective rates of single hormone therapy in EOMG group and LOMG group were 83.3% and 80.0%,respectively,and the effective rates of combined therapy were 84.8% and 95.0%,respectively.There was no significant difference between the two groups(P>0.05).3.The proportion of heavy MG combined with EOMG hormones is higher than that in the hormone treatment group(P=0.032).The total effective rate of the EOMG hormone treatment group and hormone combined treatment group was 83.3% and 84.8%.There was no significant difference in the days of hospitalization,clinical absolute score after treatmentand and crisis(P>0.05).Logistic regression analysis showed that there was no significant correlation between MG severity type,treatment plan and curative effect(P>0.05).There were significant differences in MG severity classification,clinical absolute score before treatment and serological antibodies between the two subgroups of hormone treatment group and hormone combined treatment group in patients with LOMG(P<0.05).The total effective rates of LOMG hormone treatment group and hormone combination treatment group were80% and 92.0%.Logistic regression analysis showed that the antibody classification of myasthenia gravis was related to the effective rate of treatment(pause 0.028),that is,positive ACh R-Ab was a protective factor in patients with LOMG.There was no significant correlation between MG severity type,thymic abnormality,clinical absolute score before treatment and treatment choice and effective rate(P > 0.05).Conclusion1.There was no significant difference in gender between EOMG and LOMG groups.2.EOMG and LOMG are characterized by extraocular muscle weakness as the first symptom,and type IIb is the main clinical classification,and the possibility of generalization is higher in patients with LOMG.3.The incidence of thymus hyperplasia in EOMG was higher than that in LOMG and there was no significant difference between EOMG and LOMG in serological antibody,EMG and neostigmine test.4.There was no significant difference in the total effective rate between EOMG and LOMG.5.There was no significant difference in the efficacy of hormone therapy and hormone combination therapy between EOMG group and LOMG group.6.The therapeutic effect of ACh R-Ab positive LOMG patients is good.