Bae Jong Seok, Go Seok Min, Kim Byoung Joon
Department of Neurology, Seoul Medical Center, Seoul, Korea.
J Clin Neurosci. 2006 Dec;13(10):1006-10. doi: 10.1016/j.jocn.2005.12.041. Epub 2006 Oct 30.
Although oral corticosteroids are effective for the treatment of myasthenia gravis (MG), the possibility of steroid-induced exacerbation of symptoms, especially during the initial course of steroid therapy, has limited their use patients with severe MG. However, the factors influencing or predicting in exacerbation are not well understood. The purpose of this study was to identify the clinical factors that predict the initial paradoxical exacerbation of MG in response to steroid therapy. Fifty-five consecutive patients who were administered for the first time high doses of prednisone (40-80 mg) in a tertiary medical centre in Seoul, were included. Prednisone-induced exacerbation was defined as a significant reduction in a patient's Myasthenia Gravis Severity Scale (MSS) score within 4 weeks of prednisone administration. We divided the patients into two groups on the basis of whether or not they experienced prednisone-induced exacerbation, and investigated the differences between the two groups with respect to clinical, laboratory and electrophysiological features. Twenty-three patients (42%) experienced definite exacerbation after prednisone therapy. Older age, predominantly severe bulbar symptoms, and low MSS score were found to be significant clinical predictors of exacerbation by multivariate logistic regression analysis. A high daily dosage of prednisone relative to body weight was found to be neither a predictor of exacerbation nor a predictor of early improvement in bivariate correlation analysis. Steroid-induced exacerbation in MG is a frequently encountered and challenging problem. Clinicians should be aware of the possibility of exacerbation of MG when prescribing prednisone, especially when treating elderly, bulbar dominant, or severely myasthenic patients.
尽管口服糖皮质激素对重症肌无力（MG）的治疗有效，但激素诱发症状加重的可能性，尤其是在激素治疗初始阶段，限制了其在重症MG患者中的应用。然而，影响或预测症状加重的因素尚未完全明确。本研究的目的是确定预测MG患者对激素治疗初始矛盾性加重的临床因素。纳入了在首尔一家三级医疗中心首次接受大剂量泼尼松（40 - 80毫克）治疗的55例连续患者。泼尼松诱发的加重定义为在泼尼松给药后4周内患者的重症肌无力严重程度量表（MSS）评分显著降低。我们根据患者是否经历泼尼松诱发的加重将其分为两组，并研究两组在临床、实验室和电生理特征方面的差异。23例患者（42%）在泼尼松治疗后出现明确的加重。多因素逻辑回归分析发现，年龄较大、主要为严重的延髓症状以及低MSS评分是加重的显著临床预测因素。在双变量相关分析中，相对于体重的高每日泼尼松剂量既不是加重的预测因素，也不是早期改善的预测因素。MG中激素诱发的加重是一个常见且具有挑战性的问题。临床医生在开具泼尼松处方时应意识到MG加重的可能性，尤其是在治疗老年、延髓症状为主或重症肌无力患者时。
