The Characteristics Of Juvenile Myasthenia Gravis And A Meta Analysis Of Its Prognosis

Objective: By evaluating the clinical characteristics and prognosis of JMG,to provide some clinical help and guidance for pediatricians in the diagnosis and treatment of JMG.Methods: CNKI,Wan Fang,VIP,CBM,The Cochrane Library,Pubmed,Embase was systematic searched to collect randomized controlled studies on the treatment of myasthenia gravis in children,if there was no randomized controlled studies,then searched for self-control studies,and the literatures was read and screened.Clinical characteristics and data extraction were summarized.Using the evaluation system of MGFA,the patients who achieved Complete stable remission,Pharmacologic remission,Minimal manifestations,Improved after treatment were classified as effective.The effective rate of treatment was used as the observation index.The data were analyzed by Meta analysis with Review Manager 5.3 software.Results: A total of 1346 researchers were enrolled in 8 studies.According to the method of drug use,age of onset,type of disease,gender difference,JMG and AMG,there were divided into 5 groups,Meta analysis results are as follows: 1.There was a significant difference between the Pyri group and Imm group(RR=0.68,Z=2.63,P=0.009<0.05);2.There was a significant difference between the prepubertal group and adolescent group(RR=1.47,Z=4.58,P < 0.00001);3.There was a significant difference between OMG group and GMG group(RR=1.54,Z=3.18,P=0.001 < 0.05);4.There was no obvious difference between male and female(RR=1.06,Z=0.37,P=0.71 > 0.05);5.There was a significant difference between JMG group and AMG group(RR=1.5,Z=3.16,P=0.002<0.05).Conclusion: 1.The efficacy of pyridostigmine in combination with immunosuppressants was better than that of pyridostigmine monotherapy;2.The response of prepubertal patients to treatment was better than that of adolescent patients;3.The response of OMG patients to treatment was better than GMG patients;4.There was no significant difference in the response of different sexes to treatment.5.Compared with AMG,the main type of JMG was ocular muscle type,the abnormal rate of thymus and the conversion rate of TMG were lower,and the positive rate of antibody screening was not significantly different between the two groups.No matter what therapy(pyridostigmine monotherapy or in combination withimmunosuppressants),JMG was more effective and the prognosis was higher good.