重症肌无力的鉴别诊断
- Author
- Shawn J Bird, MD
Shawn J Bird, MD
- Professor of Neurology
- University of Pennsylvania School of Medicine
- Section Editors
- Jeremy M Shefner, MD, PhD
Jeremy M Shefner, MD, PhD
- Section Editor — Neuromuscular Disease
- Professor and Chair of Neurology, Barrow Neurological Institute
- Professor of Neurology, University of Arizona, Phoenix
- Clinical Professor of Neurology, Creighton University
- Ira N Targoff, MD
Ira N Targoff, MD
- Section Editor — Muscle Disease
- Professor of Medicine, Section of Rheumatology
- University of Oklahoma Health Sciences Center
- Deputy Editor
- John F Dashe, MD, PhD
John F Dashe, MD, PhD
- Deputy Editor — Neurology
- Translators
- 李静, 主任医师
李静, 主任医师
- 中南大学湘雅医院神经内科
引言
重症肌无力(myasthenia gravis, MG)是最常见的神经肌肉传递障碍性疾病，其特征为病情呈波动性，以及眼肌、延髓肌、四肢肌和呼吸肌中的几种或全部出现无力。无力的原因是抗体介导的T细胞依赖性免疫攻击，其攻击靶点为神经肌肉接头突触后膜中的蛋白(乙酰胆碱受体或受体相关蛋白)。可通过临床和血清学检查来建立MG的诊断[1,2]。
本专题将讨论MG的鉴别诊断(包括类似于眼肌型肌无力的疾病和类似于全身型肌无力的疾病)。MG的诊断以及该病的其他问题将单独讨论。 (参见“重症肌无力的诊断”和“重症肌无力的临床表现”和“重症肌无力的发病机制”和“重症肌无力的治疗”)
重症肌无力的诊断
本文将简要总结MG的诊断，具体内容将在别处详细讨论。 (参见“重症肌无力的诊断”)
诊断MG的最佳方案依具体临床情况而变化。第一步为确定症状和体征符合MG，而非其他疾病。 (参见“重症肌无力的临床表现”)
对于上睑下垂的患者，可用床旁冰敷试验来验证MG的诊断，但该试验对于眼外肌无力的患者没有帮助。依酚氯铵(腾喜龙)试验应仅用于有明显上睑下垂或眼外肌麻痹的患者，这些患者会在用药后出现明显好转。 腾喜龙试验诊断MG的敏感性为80%-90%，但假阴性和假阳性结果很多。 (参见“重症肌无力的诊断”，关于‘床旁试验’一节)
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