An Ice-Pack Test for the Diagnosis of Myasthenia Gravis

重症肌無力症之冰塊試驗

李欣叡(Hsin-Jui Lee) ； 汪宜樺(I-Hua Wang) ； 徐文錦(Wen-Jing Hsu) ； 林治文(Chih-Wen Lin) ； 林素玲(Shun-Ling Lin)

《中華民國眼科醫學會雜誌》 40卷4期 (2001/12) Pp. 514-520

https://doi.org/10.30048/ACTASOS.200112.0005

摘要

目的：目前臨床上常使用在診斷重症肌無力症的方法很多，但這些方法不但耗時、準確性及特異性不高，甚至會產生全身性的副作用。本報告探討冰塊試驗應用在一般正常人、因重症肌無力症而導致眼瞼下垂、及非因重症肌無力症而有眼瞼下垂之病人。
病人及方法：總共收集三十八位病患，六十二個眼睛，分為三組。第一組為一般正常人、第二組為非因重症肌無力症而眼瞼下垂之病人、第三組為因重症肌無力症而導致眼瞼下垂之病人，分別紀錄冰塊試驗前後之上眼瞼邊緣至角膜上光反射點的距離。若前後差距增加大於兩公釐，則視為－陽性的結果。
結果：所有因重症肌無力症而眼瞼下垂的眼睛都可以得到陽性之結果，而不論在正常人或非因重症肌無力症而眼瞼下垂之眼睛，則沒有一個能達到陽性之結果。結論：冰塊試驗對重症肌無力症的診斷是一個相當安全、快速又有效的診斷方法。

並列摘要

Purpose: The diagnostic tests of myasthenia gravis include the administration of acetylcholinergic agents, serum antiacetylcholine receptor antibody titers, and electromyography study. Each of these tests is a time-consuming procedure. We present a new method and evaluate the results of ice-pack test in normal subjects, patients with myasthenic ptosis and with non-myasthenic ptosis.
Methods: Nine patients (12 eyes) with myasthenic ptosis, nineteen patients (30 eyes) with non-myasthenic ptosis, and ten normal subjects (20 eyes) were enrolled in this study. MRD1 (margin reflex distance 1) was measured before and immediately after a 2- minute application of ice on the ptotic eyelid.
Results: Two or more millimeters of improvement in MRD1 after the application of ice was considered as a positive result. A positive ice-pack test result was noted in all of the 12 eyes with myasthenic ptosis, but none of the 20 normal eyes and of the 30 eyes with non-myasthenic ptosis.
Conclusions: Lowering surface temperature can improve neuromuscular transmission. The ice-pack test is a safe, simple, short and specific office test for the diagnosis of myasthenia gravis, and it may eliminate the need of edrophonium chloride (Tensilon) or neostigmine methylsulfate (Prostigmin) test in many patients.

並列關鍵字

ice-pack test ； myasthenia gravis