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重症肌无力病人的临床绝对评分法和相对评分法

A clinical absolute and relative score system for myasthenia gravis

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【作者】 王秀云许贤豪孙宏韩雄张华国红

【Author】 Wang Xiuyun, Xu Xianhao, Sun Hong, et al. Department of Neurology, Beijing Hospital, Ministry of Health, Beijing 100730

【机构】 卫生部北京医院神经科

【摘要】 提出并详细描述一种对重症肌无力(MG)病人的临床绝对和相对评分法。方法运用统计学方法对这一评分法的可靠性和敏感性做了检验,对20例MG病人的临床绝对评分结果做Kappa检验;对12例MG病人的相对评分结果做t检验。结果表明本方法可重复性较好,且能敏感地反映出临床病情变化,是一种评价MG病人受累肌群肌肉无力情况及临床治疗效果的较为精确和稳定的量表化方法。结论临床绝对评分法和相对评分法对判断重症肌无力患者的病情和疗效具有一定的必要性和可行性。

【Abstract】 Objective To propose a clinical absolute and relative score system for myasthenia gravis and make its evaluation. Methods The system consisted of two parts, the absolute scores and the relative scores. The absolute scores included 8 items: ptosis, palpebra superior fatigability, disability of ocular motion, fatigability of the upper and lower extremity muscles, disability of the facial muscles, chewing difficulties, dysphagia and disability of the respiratory muscles. Each item had five possible scores, ranging from 0 (the signs and symptoms being absent) to 4 (the most severe dysfunction). The relative scores were obtained with the scores before treatment subtracted by the scores after treatment and then divided by the scores before treatment. The higher the relative scores, the more significant the changes of the disabilities. If the scores were more than zero, it indicated the patient’s condition had improved. On the other hand, if the scores became less than zero, it suggested that the patient got worse. The absolute scores of 20 MG patients observed by 5 neurologists were tested with Kappa values to evaluate the degree of agreement among different observers (i.e. reliability); and the relative scores of 12 MG patients before vs after treatment were tested with Student’s t test, to examine their abilities of detecting the changes in the MG patients with disabilities (i.e. sensitivity). Result It proved to be reliable for interobserver agreement (K=0.51 ̄0.97) and sensitive ( P <0.001) to detect clinically relevant changes. Conclusion The clinical score system appeared to offer an accurate quantitative means of evaluating the disabilities in MG patients. It would be useful in monitoring the effects of therapy in MG cases.

【关键词】 重症肌无力; 肌肉无力的严重程度; 评分方法; 绝对评分; 相对评分;

【Key words】 Myasthenia gravis Severity of muscle weakness Scoring system Absolute score Relative score;

【分类号】R746.1;R322.74;R195.1;

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