摘要： 目的 观察环磷酰胺治疗伴胸腺瘤的重症肌无力的有效性和安全性。方法 共95 例伴胸腺瘤的重症肌无力患者，其中60 例接受环磷酰胺0.20 g/次（2 次/周）治疗，逐渐增加剂量至0.80 g/次（1 次/周），当总剂量达6 和10 g 时，采用许氏评分法进行疗效评价并记录药物不良反应。结果 与治疗前（19.65 ± 8.90）相比，总剂量达6 g（13.73 ± 8.63）和10 g（10.58 ± 8.11）时临床绝对评分降低（均P <0.05），治疗总有效率为73.33%（44/60）和81.67%（49/60），药物不良反应轻微且可耐受。结论 环磷酰胺治疗伴胸腺瘤的重症肌无力疗效显著且安全性良好，推荐在临床应用；药物安全性仍待进一步观察。

关键词: 重症肌无力, 胸腺瘤, 环磷酰胺

Abstract: Objective  To evaluate the efficacy and safety of cyclophosphamide in the treatment of patients with myasthenia gravis (MG) and thymoma.  Methods  Ninety-five MG patients with thymoma were selected, and 60 of them were finally involved in the study. Patients were given low or median dose of cyclophosphamide (0.20 g intravenously per day, twice a week), and the dose was gradually increased to 0.80 g intravenously per week. When the total dose of cyclophosphamide reached 6 and 10 g, the drug efficacy was respectively assessed by Clinical Absolute Score (CAS) and Clinical Relative Score (CRS). Adverse events were also recorded. Results  Compared with the score before treatment (19.65 ± 8.90), the CAS after 6 g (13.73 ± 8.63) and 10 g (10.58 ± 8.11) cyclophosphamide treatment were significantly lower than that of before treatment (P < 0.05, for all). The drug efficacy of the treatment was 73.33% (44/60) and 81.67% (49/60) when the total dose reached 6 and 10 g, respectively. No serious adverse reactions occurred.  Conclusions  Cyclophosphamide is an effective and safe treatment for post-thymectomized patients with myasthenia gravis and thymoma. Further follow-up and study is still needed to evaluate the long-term outcome.

Key words: Myasthenia gravis, Thymoma, Cyclophosphamide