眼肌型重癥肌無力治療措施的臨床證據_《中國循證醫學雜志》

作者：

鐘捷 ¹ ,  吳波 ²

1. 四川省醫學科學院四川省人民醫院眼科（成都 610072）； 2. 四川大學華西醫院神經內科（成都 610041）;

關鍵詞：

眼肌型重癥肌無力治療臨床證據

DOI：

10.7507/1672-2531.20100490

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目的　為眼肌型重癥肌無力患者循證制定最佳治療方案。
方法　檢索PubMed（1966～2010.4）、Cochrane圖書館（2010年第1期）、中國知識資源總庫（1979～2010.4）及中文科技期刊數據庫（1989～2010.4），獲取并評價有關膽堿酯酶抑制劑、糖皮質激素、免疫球蛋白、免疫抑制劑、血漿置換和胸腺切除的臨床指南、系統評價、隨機對照試驗、臨床對照試驗及病例觀察研究。
結果　共納入與眼肌型重癥肌無力治療有關的治療指南2篇、系統評價5篇、觀察性研究4篇，其分別評價了膽堿酯酶抑制劑、糖皮質激素、免疫球蛋白、免疫抑制劑及胸腺切除的療效與安全性。眼肌型重癥肌無力患者應首選溴吡斯的明治療，若患者不能自發緩解，應在充分評估使用糖皮質激素的利弊后考慮使用激素治療，激素療效欠佳時可考慮加用免疫抑制劑長期服用以緩解癥狀。血漿置換術不作為眼肌型重癥肌無力的推薦治療，對合并胸腺瘤的患者應施行胸腺切除術。
結論　借助循證醫學的方法可為眼肌型重癥肌無力患者的治療提供最佳臨床證據。

引用本文： 鐘捷,吳波. 眼肌型重癥肌無力治療措施的臨床證據. 中國循證醫學雜志, 2010, 10(6): 763-765. doi: 10.7507/1672-2531.20100490 復制

1.	Barton JJ, Fouladvand M. Ocular aspects of myasthenia gravis. Semin Neurol, 2000, 20(1): 7-20.
2.	Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, [Epub ahead of print].
3.	Benatar M, Kaminski HJ. Quality Standards Subcommittee of the American Academy of Neurology. Evidence report: the medical treatment of ocular myasthenia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2007, 68(24): 2144-2149.
4.	Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2000, 55(1): 7-15.
5.	Benatar M, Kaminski H. Medical and surgical treatment for ocular myasthenia. Cochrane Database Syst Rev, 2006, 19(2): CD005081.
6.	Hart IK, Sathasivam S, Sharshar T. Immunosuppressive agents for myasthenia gravis. Cochrane Database Syst Rev, 2007, 17(4):CD005224.
7.	Schneider-Gold C, Gajdos P, Toyka KV, et al. Corticosteroids for myasthenia gravis. Cochrane Database Syst Rev, 2005, 18(2):CD002828.
8.	Gajdos P, Chevret S, Toyka K. Intravenous immunoglobulin for myasthenia gravis. Cochrane Database Syst Rev. Cochrane Database Syst Rev, 2008, 23(1): CD002277.
9.	Kupersmith MJ, Ying G. Ocular motor dysfunction and ptosis in ocular myasthenia gravis: efects of treatment. Br J Ophthalmol, 2005, 89(10): 1330-1334．.
10.	Monsul NT, PatwaHS, KnorrAM, et al. The effect of prednisolie on the progression from oc ular to generalized myas thenia gravis. J Neurol Sci, 2004, 217(2): 131-133．.
11.	Kupersmith MJ, Latkany R, Homel P. Development of generalized disease at 2 years in patients with oc ular myasthenia gravis. Arch Neurol, 2003, 60(2): 243-248．.
12.	Sommer N, Sigg B, Melms A, et al. Ocular myasthenia gravis: response to long-term immunenosuppressive treatment. J Neurol Neurosurg Psychiatry, 1997, 62(2): 156-162.

1. Barton JJ, Fouladvand M. Ocular aspects of myasthenia gravis. Semin Neurol, 2000, 20(1): 7-20.
2. Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, [Epub ahead of print].
3. Benatar M, Kaminski HJ. Quality Standards Subcommittee of the American Academy of Neurology. Evidence report: the medical treatment of ocular myasthenia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2007, 68(24): 2144-2149.
4. Gronseth GS, Barohn RJ. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2000, 55(1): 7-15.
5. Benatar M, Kaminski H. Medical and surgical treatment for ocular myasthenia. Cochrane Database Syst Rev, 2006, 19(2): CD005081.
6. Hart IK, Sathasivam S, Sharshar T. Immunosuppressive agents for myasthenia gravis. Cochrane Database Syst Rev, 2007, 17(4):CD005224.
7. Schneider-Gold C, Gajdos P, Toyka KV, et al. Corticosteroids for myasthenia gravis. Cochrane Database Syst Rev, 2005, 18(2):CD002828.
8. Gajdos P, Chevret S, Toyka K. Intravenous immunoglobulin for myasthenia gravis. Cochrane Database Syst Rev. Cochrane Database Syst Rev, 2008, 23(1): CD002277.
9. Kupersmith MJ, Ying G. Ocular motor dysfunction and ptosis in ocular myasthenia gravis: efects of treatment. Br J Ophthalmol, 2005, 89(10): 1330-1334．.
10. Monsul NT, PatwaHS, KnorrAM, et al. The effect of prednisolie on the progression from oc ular to generalized myas thenia gravis. J Neurol Sci, 2004, 217(2): 131-133．.
11. Kupersmith MJ, Latkany R, Homel P. Development of generalized disease at 2 years in patients with oc ular myasthenia gravis. Arch Neurol, 2003, 60(2): 243-248．.
12. Sommer N, Sigg B, Melms A, et al. Ocular myasthenia gravis: response to long-term immunenosuppressive treatment. J Neurol Neurosurg Psychiatry, 1997, 62(2): 156-162.

《中國循證醫學雜志》

眼肌型重癥肌無力治療措施的臨床證據

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《中國循證醫學雜志》

眼肌型重癥肌無力治療措施的臨床證據

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