ObjectiveTo analyze the surgical efficacy and influencing factors of myasthenia gravis (MG) patients with thymic atrophy after thymectomy. MethodsThe clinical data of MG patients with thymic atrophy undergoing thymectomy between October 2014 and May 2018 in Daping Hospital of Army Medical University and Shijiazhuang People Hospital were retrospectively analyzed. ResultsA total of 71 patients were collected, including 40 males and 31 females with a mean age of 45.17±12.42 years. All patients received the surgery successfully. After the surgery, 20 (28.17%) patients were stable remission, 12 (16.90%) patients were minimal manifestation status,19 (26.76%) patients were improved, 5 (7.04%) patients showed no change, 3 (4.23%) patients were worsened, 10 (14.08%) patients were exacerbated and 2 (2.82%) patients were dead. Multivariate logistic regression analysis showed that the preoperative illness duration (OR=4.61, 95%CI 1.13-18.85, P=0.03), and postoperative pyridostigmine combined with immunosuppressive (OR=0.12, 95%CI 0.03-0.45, P=0.00) were independent risk factors for long-term efficacy of thymectomy for MG patients with thymic atrophy. ConclusionEarly surgery after diagnosis of MG and postoperative pyridostigmine combined with immunosuppressive treatment is beneficial to the prognosis of MG patients with thymic atrophy.
Objective To assess the clinical value of efgartigimod as a rapid induction therapy in the perioperative management of patients with myasthenia gravis (MG) undergoing thymectomy. Methods This retrospective study collected data from MG patients who underwent thymectomy at Myasthenia Gravis Diagnosis and Treatment Center, Shijiazhuang First People’s Hospital between October 2023 and July 2024. Patients were categorized into an efgartigimod group and a control group based on whether they received efgartigimod prior to thymectomy. Data collected included patient demographics (age at onset, sex), thymic pathology, preoperative immunosuppressant use, Myasthenia Gravis Foundation of America (MGFA) classification at 3 days pre- and 1 week post-surgery, postoperative complications, quantitative myasthenia gravis (QMG) scores, antibody titers, total IgG titers, and CD19+ B cell percentages. Hypothesis testing and multiple linear regression models were employed to analyze whether preoperative efgartigimod improved patient recovery. Results A total of 57 patients were included (16 males, 41 females), with a median age of 50 (35, 65) years, consistent with the typical MG demographic. Preoperative efgartigimod use was associated with a 38.0% reduction in postoperative QMG scores [adjusted β regression coefficient=0.38 (0.16, 0.60), adjusted P=0.001] and an increased likelihood of improvement in postoperative MGFA classification [adjusted OR=–1.98 (–3.08, –0.89), adjusted P<0.001]. Regarding immunological markers, preoperative efgartigimod was associated with significant reductions in postoperative total IgG levels [adjusted β regression coefficient=0.42 (0.30, 0.53), adjusted P<0.001] and antibody titers [adjusted β regression coefficient=0.27 (0.16, 0.38), adjusted P<0.001]. However, it had no significant effect on the proportion of CD19+ B cells [adjusted β regression coefficient=–1.37 (–3.26, 0.53), adjusted P=0.151]. Conclusion For MG patients undergoing thymectomy, preoperative efgartigimod treatment can significantly accelerate postoperative recovery and reduce postoperative total IgG and MG-related antibody levels.
