Department of General Pathology and Pathological Physiology, Institute of Experimental Medicine, 197376, St. Petersburg, Russia.
Department of Neurology and Psychiatry, Almazov National Medical Research Centre, 197341, St. Petersburg, Russia.
J Neurol. 2020 Jun;267(6):1802-1811. doi: 10.1007/s00415-020-09767-7. Epub 2020 Mar 5.
Depressive symptoms in myasthenia gravis (MG) are common, may mimic other disease features, and contribute to misdiagnosis and diagnostic delay. Nevertheless, the clinical determinants of depressive symptoms in MG remain poorly studied, in particular their overlap with fatigue. Moreover, studies in MG have rarely looked at distinct depression phenotypes.
In 68 consecutive MG patients, we ascertained cognitive-affective and somatic depression with the Beck Depression Inventory (BDI), and also assessed age at disease onset, education, marital state, work ability, sleepiness, fatigue, and treatment modalities. Disease severity was graded according to the Myasthenia Gravis Foundation of America (MGFA) classification.
The prevalence of moderate-severe depression was 20.5%. While depression and fatigue showed large overlap (n = 37, 54.4%), only fatigue increased with disease severity, while BDI scores did not. Thymectomy was independently associated with lower BDI scores, but had no impact on fatigue. Total BDI scores were similar in patients with predominantly cognitive-affective and with predominantly somatic depression. However, ESS correlated only with cognitive-affective BDI, and younger age was independently associated with cognitive-affective BDI. Conversely, female sex and thymectomy were independently associated with somatic BDI.
Depression and fatigue are highly prevalent and largely overlapping comorbidities in MG, but only fatigue increased with disease severity, and only depression was milder in thymectomized patients. Comparative use of BDI subscales in MG reveals distinct depression phenotypes with distinct correlations to other disease features.
重症肌无力（MG）患者常伴有抑郁症状，这些症状可能与其他疾病特征相似，并导致误诊和诊断延迟。然而，MG 患者抑郁症状的临床决定因素仍研究甚少，特别是它们与疲劳的重叠。此外，MG 研究很少关注不同的抑郁表型。
我们在 68 例连续的 MG 患者中，使用贝克抑郁量表（BDI）确定认知情感和躯体性抑郁，并评估疾病发病年龄、教育程度、婚姻状况、工作能力、嗜睡、疲劳和治疗方式。疾病严重程度根据美国重症肌无力基金会（MGFA）分类进行分级。
中重度抑郁的患病率为 20.5%。虽然抑郁和疲劳有很大的重叠（n=37，54.4%），但只有疲劳随疾病严重程度增加，而 BDI 评分没有。胸腺切除术与较低的 BDI 评分独立相关，但对疲劳没有影响。主要表现为认知情感性和躯体性抑郁的患者的总 BDI 评分相似。然而，ESS 仅与认知情感性 BDI 相关，而年龄较小与认知情感性 BDI 独立相关。相反，女性和胸腺切除术与躯体性 BDI 独立相关。
抑郁和疲劳是 MG 中高度普遍且高度重叠的共病，但只有疲劳随疾病严重程度增加，而只有抑郁在胸腺切除术后患者中较轻。在 MG 中比较使用 BDI 亚量表可以揭示出具有不同相关性的不同抑郁表型。
