PDF(Pubmed)
Abstract：
UNASSIGNED: Thymectomy is an efficient and standard treatment strategy for patients with myasthenia gravis (MG), postoperative myasthenic crisis (POMC) is the major complication related to thymectomy and has a strongly life-threatening effect. As a biomarker, whether the bilirubin level is a risk factor for MG progression remains unclear. This study aimed to investigate the association between the preoperative bilirubin level and postoperative myasthenic crisis (POMC).
UNASSIGNED: We analyzed 375 patients with MG who underwent thymectomy at Tangdu Hospital between January 2012 and September 2021. The primary outcome measurement was POMC. The association between POMC and bilirubin level was analyzed by restricted cubic spline (RCS). Indirect bilirubin (IBIL) was divided into two subgroups based on the normal upper limit of IBIL, 14 μmol/L.
UNASSIGNED: Compared with non-POMC group, IBIL levels were significantly higher in patients with POMC. Elevated IBIL levels were closely associated with an increased risk of POMC (p for trend = 0.002). There was a dose-response curve relationship between IBIL levels and POMC incidence (p for non-linearity = 0.93). However, DBIL levels showed a U-shaped association with POMC incidence. High IBIL level (≥14 μmol/L) was an independent predictive factor for POMC [odds ratio = 3.47, 95% confidence interval (CI): 1.56-7.8, p = 0.002]. The addition of high IBIL levels improved the prediction model performance (net reclassification index = 0.186, 95% CI: 0.039-0.334; integrated discrimination improvement = 0.0345, 95% CI: 0.005-0.065).
UNASSIGNED: High preoperative IBIL levels, especially those exceeding the normal upper limit, could independently predict the incidence of POMC.
UNASSIGNED: We analyzed 375 patients with MG who underwent thymectomy at Tangdu Hospital between January 2012 and September 2021. The primary outcome measurement was POMC. The association between POMC and bilirubin level was analyzed by restricted cubic spline (RCS). Indirect bilirubin (IBIL) was divided into two subgroups based on the normal upper limit of IBIL, 14 μmol/L.
UNASSIGNED: Compared with non-POMC group, IBIL levels were significantly higher in patients with POMC. Elevated IBIL levels were closely associated with an increased risk of POMC (p for trend = 0.002). There was a dose-response curve relationship between IBIL levels and POMC incidence (p for non-linearity = 0.93). However, DBIL levels showed a U-shaped association with POMC incidence. High IBIL level (≥14 μmol/L) was an independent predictive factor for POMC [odds ratio = 3.47, 95% confidence interval (CI): 1.56-7.8, p = 0.002]. The addition of high IBIL levels improved the prediction model performance (net reclassification index = 0.186, 95% CI: 0.039-0.334; integrated discrimination improvement = 0.0345, 95% CI: 0.005-0.065).
UNASSIGNED: High preoperative IBIL levels, especially those exceeding the normal upper limit, could independently predict the incidence of POMC.
摘要：
■胸腺切除术是重症肌无力（MG）患者的有效和标准治疗策略，术后肌无力危象（POMC）是与胸腺切除术相关的主要并发症，具有强烈的危及生命的作用。作为生物标志物,胆红素水平是否是MG进展的危险因素尚不清楚.本研究旨在探讨术前胆红素水平与术后肌无力危象(POMC)的关系。
我们分析了2012年1月至2021年9月在唐都医院接受胸腺切除术的375例MG患者。主要结果测量为POMC。采用约束三次样条(RCS)分析POMC与胆红素水平的相关性。间接胆红素（IBIL）根据IBIL的正常上限分为两个亚组，14μmol/L
■与非POMC组相比，POMC患者的IBIL水平明显较高。IBIL水平升高与POMC风险增加密切相关(趋势p=0.002)。IBIL水平和POMC发生率之间存在剂量-反应曲线关系(非线性p=0.93)。然而,DBIL水平与POMC发病率呈U型相关。高IBIL水平（≥14μmol/L）是POMC的独立预测因素[比值比=3.47，95％置信区间（CI）：1.56-7.8，p=0.002]。高IBIL水平的加入提高了预测模型性能(净重新分类指数=0.186,95%CI:0.039-0.334;综合判别改进=0.0345,95%CI:0.005-0.065)。
■术前IBIL水平高，尤其是那些超过正常上限的，可以独立预测POMC的发病率。
我们分析了2012年1月至2021年9月在唐都医院接受胸腺切除术的375例MG患者。主要结果测量为POMC。采用约束三次样条(RCS)分析POMC与胆红素水平的相关性。间接胆红素（IBIL）根据IBIL的正常上限分为两个亚组，14μmol/L
■与非POMC组相比，POMC患者的IBIL水平明显较高。IBIL水平升高与POMC风险增加密切相关(趋势p=0.002)。IBIL水平和POMC发生率之间存在剂量-反应曲线关系(非线性p=0.93)。然而,DBIL水平与POMC发病率呈U型相关。高IBIL水平（≥14μmol/L）是POMC的独立预测因素[比值比=3.47，95％置信区间（CI）：1.56-7.8，p=0.002]。高IBIL水平的加入提高了预测模型性能(净重新分类指数=0.186,95%CI:0.039-0.334;综合判别改进=0.0345,95%CI:0.005-0.065)。
■术前IBIL水平高，尤其是那些超过正常上限的，可以独立预测POMC的发病率。
