| 摘要: |
| ［摘要］ 重症肌无力（MG）是由胸腺异常导致的自身免疫性疾病。胸腺切除术是MG的核心治疗手段，其临床价值已被重症肌无力胸腺切除术的随机试验（MGTX）等里程碑式研究证实，能显著改善乙酰胆碱受体抗体（AChR-Ab）阳性全身型MG患者的临床结局，减少免疫抑制剂用量，并提高长期缓解率。随着胸腔镜及机器人等微创技术的进步，手术已进入更安全、恢复更快的“微创、精准”新阶段。对于早发型、AChR-Ab阳性的全身型MG患者，早期手术已成为临床共识。然而，该手术在眼肌型MG、MuSK抗体阳性MG等特殊人群中的应用尚存争议，需个体化评估。未来的方向是建立基于患者亚型和生物标志物的精准决策模型，并通过大规模研究明确其在不同MG亚型中的精准定位，以优化手术时机与筛选获益人群，实现个体化治疗。 |
| 关键词: 胸腺切除术 重症肌无力 自身免疫性疾病 重症肌无力胸腺切除术的随机试验 |
| DOI：10.3969/j.issn.1674-3806.2025.10.02 |
| 分类号: |
| 基金项目:国家自然科学基金项目（编号：82172655） |
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| Advancements in thymectomy for myasthenia gravis |
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KUANG Zhenyu, ZHU Quan, LU Liqing, LI Xiaoyan, SU Yanhong, CHENG Yuanda, GAO Yang, ZHANG Chunfang
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Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha 410000, China
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| Abstract: |
| ［Abstract］ Myasthenia gravis(MG) is an autoimmune disease caused by thymic abnormalities. Thymectomy is a core approach for treating MG, and its clinical value has been confirmed by landmark studies such as the Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone Therapy(MGTX). Thymectomy can significantly improve the clinical outcomes of patients with acetylcholine receptor antibody(AChR-Ab)-positive generalized MG, reduce their immunosuppressant dosages, and elevate their long-term remission rates. With the advancement of minimally invasive techniques such as thoracoscopy and robotics, thymectomy has entered a new stage of “minimally invasive and precise”, which makes patients safer and enables them to recover faster. Early thymectomy is now the consensus recommendation for patients with early-onset and AChR-Ab-positive generalized MG. However, its applications in some special populations, including those with ocular MG and muscle-specific kinase(MuSK) antibody-positive MG, remain controversial and require individualized assessment. The future research direction lies in establishing precision decision-making models based on patient subtypes and biomarkers, and conducting large-scale studies to define its precise role across different MG subtypes, which will optimize surgical timing and screen beneficiary groups to achieve personalized treatments. |
| Key words: Thymectomy Myasthenia gravis(MG) Autoimmune diseases The Thymectomy Trial in Non-Thymomatous Myasthenia Gravis Patients Receiving Prednisone Therapy(MGTX) |
