眼肌型重症肌无力治疗措施的临床证据_《中国循证医学杂志》

作者：

钟捷 ¹ ,  吴波 ²

1. 四川省医学科学院四川省人民医院眼科（成都 610072）； 2. 四川大学华西医院神经内科（成都 610041）;

关键词：

眼肌型重症肌无力治疗临床证据

DOI：

10.7507/1672-2531.20100490

视频：

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目的　为眼肌型重症肌无力患者循证制定最佳治疗方案。
方法　检索PubMed（1966～2010.4）、Cochrane图书馆（2010年第1期）、中国知识资源总库（1979～2010.4）及中文科技期刊数据库（1989～2010.4），获取并评价有关胆碱酯酶抑制剂、糖皮质激素、免疫球蛋白、免疫抑制剂、血浆置换和胸腺切除的临床指南、系统评价、随机对照试验、临床对照试验及病例观察研究。
结果　共纳入与眼肌型重症肌无力治疗有关的治疗指南2篇、系统评价5篇、观察性研究4篇，其分别评价了胆碱酯酶抑制剂、糖皮质激素、免疫球蛋白、免疫抑制剂及胸腺切除的疗效与安全性。眼肌型重症肌无力患者应首选溴吡斯的明治疗，若患者不能自发缓解，应在充分评估使用糖皮质激素的利弊后考虑使用激素治疗，激素疗效欠佳时可考虑加用免疫抑制剂长期服用以缓解症状。血浆置换术不作为眼肌型重症肌无力的推荐治疗，对合并胸腺瘤的患者应施行胸腺切除术。
结论　借助循证医学的方法可为眼肌型重症肌无力患者的治疗提供最佳临床证据。

引用本文： 钟捷,吴波. 眼肌型重症肌无力治疗措施的临床证据. 中国循证医学杂志, 2010, 10(6): 763-765. doi: 10.7507/1672-2531.20100490 复制

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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.

《中国循证医学杂志》

眼肌型重症肌无力治疗措施的临床证据

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《中国循证医学杂志》

眼肌型重症肌无力治疗措施的临床证据

摘要 全文 图表 视频 参考文献 施引文献 补充材料

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