摘要： 目的 探讨糖皮质激素冲击治疗诱发重症肌无力危象之临床特点和危险因素。方法 共59 例次重症肌无力患者分别于入院时和糖皮质激素冲击治疗第4、7、14、21、28 天时采用临床绝对评分判断病情严重程度、临床相对评分评价病情变化，并分析危象发作危险因素。结果 在糖皮质激素冲击治疗过程中约69.49%（41/59）患者出现短暂性肌无力，重症肌无力危象组患者治疗第4 天时临床绝对评分短暂性升高（37.63 ± 1.80；t = 4.410，P = 0.028），第7 天开始下降（32.94 ± 2.29），至第14 天（22.19 ± 1.75）低于入院时（31.31 ± 2.07；t = 12.701，P = 0.000）；非重症肌无力危象组患者治疗后临床绝对评分下降，第14 天（12.37 ± 1.11）低于入院时（21.27 ± 1.39；t = 5.740，P = 0.000），与临床表现改善程度一致。重症肌无力危象组患者治疗第7 天临床相对评分逐渐增加［（-0.06 ± 0.06）％］，至第28 天［（0.82 ± 0.03）％］高于第4 天［（-0.23 ± 0.05）％；t = 28.232，P = 0.000］；非重症肌无力危象组患者治疗后临床相对评分亦逐渐增加，至第21 天［（0.53 ± 0.04）％］高于第4 天［（0.03 ± 0.04）％；t = 4.312，P = 0.000］。Logistic 回归分析提示，高龄、临床绝对评分增加、感染、延髓肌麻痹、合并其他自身免疫性疾病均可诱发危象，但以高龄为主要诱发因素。结论 糖皮质激素冲击治疗过程中通过筛查危险因素、密切观察病情变化，可以及时发现危象病例，经呼吸机辅助通气和静脉注射免疫球蛋白可以缓解病情，挽救患者生命。

关键词: 重症肌无力, 甲泼尼龙, 危险因素, 回归分析

Abstract: Objective  To investigate the clinical features and risk factors for myasthenia gravis crisis (MGC) after impact therapy of glucocorticoid.  Methods  Clinical data of 59 MG patients were retrospectively analyzed. All of them received high-dose glucocorticoid treatment, and 16 patients developed into MGC. Clinical Absolute Score (CAS) was obtained on admission, then at 4, 7, 14, 21, 28 d after treatment initiation, so as to evaluate the severity of disease. Clinical Relative Score (CRS) was used to evaluate the changes of patients' condition. The clinical features, scores and risk factors in MGC group were compared with non-MGC (NMGC) group. Results Most patients (69.49% , 41/59) had transient muscle weakness after glucocorticoid impact therapy. CAS of MGC group increased at 4 d (37.63 ± 1.80; t = 4.410, P = 0.028), then decreased at 7 d (32.94 ± 2.29), until 14 d after therapy (22.19 ± 1.75), which was significantly lower than that before treatment (31.31 ± 2.07; t = 12.701, P = 0.000). CAS of NMGC group showed a downward trend after treatment. It showed a significant decrease at 14 d after therapy (12.37 ± 1.11) compared with that before treatment (21.27 ± 1.39; t = 5.740, P = 0.000), which was consistent with its clinical manifestations. In MGC group, CRS increased gradually from 7 d [(-0.06 ± 0.06)%] after treatment till 28 d [(0.82 ± 0.03)%], which was significantly different from 4 d [(-0.23 ± 0.05)%; t = 28.232, P = 0.000). Similarly, CRS of NMGC group increased gradually and showed significant difference till 21 d [(0.53 ± 0.04)%] when compared with 4 d [(0.03 ± 0.04)%; t = 4.312, P = 0.000]. Logistic regression analysis showed relative old age, increasing CAS, infection, bulbar muscular weakness and comorbid immunological disorders were crisis-prone factors, but old age was the only factor closely related to the occurrence of MGC.  Conclusions  Relative old age maybe the risk factor for MGC after impact therapy of glucocorticoid. Monitoring the disease change closely, screening out high-risk patients timely, intravenous immunoglobulin (IVIg) and respiratory support are all very important for successful treatment and low mortality.

Key words: Myasthenia gravis, Methylprednisolone, Risk factors, Regression analysis