新型冠状病毒肺炎对法国重症肌无力队列的影响。
Impact of Coronavirus Disease 2019 in a French Cohort of Myasthenia Gravis.
机构信息
From the Referral Center for Neuromuscular Diseases AOC (G.S., S.M., G.L.M., A.S., F.D., L.C., M.-H.V.) and ALS Center (S.M., G.L.M., A.S., L.C.), Nerve-Muscle Unit, University Hospitals of Bordeaux (Pellegrin Hospital), University of Bordeaux; Department of Intensive Care (D.F., D.A., B.C.), Raymond Poincare University Hospital, Garches; Referral Center for Neuromuscular Diseases and ALS (E.S.-C., S.A.) and Referral Center for Neuromuscular Diseases, Neuropediatric Unit (F.A.), Timone University Hospital, Aix-Marseille University, Marseille; Department of Neurology, Referral Center for Neuromuscular Diseases (C.T.), University Hospitals of Lille; ENMG Unit, Referral Center for Neuromuscular Diseases (F.B.), University Hospitals of Lyon (Neurologic Hospital Pierre Wertheimer); Referral Center for Neuromuscular Diseases (A.M.), University Hospitals of Nantes; Inserm, UMR1219 (T.S., A.F.-S.), Bordeaux Population Health Research Center, ISPED, University of Bordeaux; Neurodegenerative Diseases Institute, French Reference Centre for MSA (T.S., A.F.-S.), University Hospitals of Bordeaux; AFM-Téléthon (S.S.-K.), Evry; Department of Neurology (L.K.), General Hospital of Le Mans; Department of Neurology (J.-C.A.), University Hospital of Saint-Etienne; Clinical Neurophysiology and Epileptology Department (G.B.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Neurology Department (L.K., J.-B.C., A.N.-P.), Referral Center for Neuromuscular Diseases "Nord-Est-Ile de France," University Hospitals of Strasbourg; APHP (Pitié-Salpêtrière Hospital) (T.S.), Referral Center for Neuromuscular Diseases "Nord-Est-Ile de France," Sorbonne University, Paris; Referral Center for Neuromuscular Diseases, Department of Neurology (P.C.), University Hospitals of Toulouse (Purpan Hospital); and Referral Center for Neuromuscular Diseases, Department of Neurology (M.S.), University Hospital of Angers, France.
出版信息
Neurology. 2021 Apr 20;96(16):e2109-e2120. doi: 10.1212/WNL.0000000000011669. Epub 2021 Feb 10.
OBJECTIVE
To describe the clinical characteristics and outcomes of coronavirus disease 2019 (COVID-19) among patients with myasthenia gravis (MG) and identify factors associated with COVID-19 severity in patients with MG.
METHODS
The CO-MY-COVID registry was a multicenter, retrospective, observational cohort study conducted in neuromuscular referral centers and general hospitals of the FILNEMUS (Filière Neuromusculaire) network (between March 1, 2020, and June 8, 2020), including patients with MG with a confirmed or highly suspected diagnosis of COVID-19. COVID-19 was diagnosed based on a PCR test from a nasopharyngeal swab or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology, thoracic CT scan, or typical symptoms. The main outcome was COVID-19 severity based on location of treatment/management (home, hospitalized in a medical unit, or in an intensive care unit). We collected information on demographic variables, general history, and risk factors for severe COVID-19. Multivariate ordinal regression models were used to identify factors associated with severe COVID-19 outcomes.
RESULTS
Among 3,558 patients with MG registered in the French database for rare disorders, 34 (0.96%) had COVID-19. The mean age at COVID-19 onset was 55.0 ± 19.9 years (mean MG duration: 8.5 ± 8.5 years). By the end of the study period, 28 patients recovered from COVID-19, 1 remained affected, and 5 died. Only high Myasthenia Gravis Foundation of America (MGFA) class (≥IV) before COVID-19 was associated with severe COVID-19 ( 0.004); factors that were not associated included sex, MG duration, and medium MGFA classes (≤IIIb). The type of MG treatment had no independent effect on COVID-19 severity.
CONCLUSIONS
This registry-based cohort study shows that COVID-19 had a limited effect on most patients, and immunosuppressive medications and corticosteroids used for MG management are not risk factors for poorer outcomes. However, the risk of severe COVID-19 is elevated in patients with high MGFA classes (odds ratio, 102.6 [4.4-2,371.9]). These results are important for establishing evidence-based guidelines for the management of patients with MG during the COVID-19 pandemic.
目的
描述重症肌无力（MG）患者中 2019 年冠状病毒病（COVID-19）的临床特征和结局，并确定与 MG 患者 COVID-19 严重程度相关的因素。
方法
CO-MY-COVID 登记册是一项多中心、回顾性、观察性队列研究，在神经肌肉转诊中心和 FILNEMUS（Filière Neuromusculaire）网络的综合医院进行（2020 年 3 月 1 日至 2020 年 6 月 8 日），包括确诊或高度疑似 COVID-19 的 MG 患者。COVID-19 的诊断依据是鼻咽拭子的 PCR 检测或严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）血清学、胸部 CT 扫描或典型症状。主要结局是根据治疗/管理地点（家庭、医疗单位住院或重症监护病房）评估 COVID-19 严重程度。我们收集了人口统计学变量、一般病史和严重 COVID-19 危险因素的信息。多变量有序回归模型用于确定与严重 COVID-19 结局相关的因素。
结果
在法国罕见疾病数据库中登记的 3558 例 MG 患者中，有 34 例（0.96%）患有 COVID-19。COVID-19 发病时的平均年龄为 55.0±19.9 岁（MG 病程平均为 8.5±8.5 年）。在研究结束时，28 例患者从 COVID-19 中康复，1 例仍受影响，5 例死亡。仅 COVID-19 前高肌无力基金会（MGFA）分级（≥IV）与严重 COVID-19 相关（0.004）；与 COVID-19 严重程度无关的因素包括性别、MG 病程和中 MGFA 分级（≤IIIb）。MG 治疗类型对 COVID-19 严重程度没有独立影响。
结论
这项基于登记的队列研究表明，COVID-19 对大多数患者的影响有限，用于 MG 管理的免疫抑制药物和皮质类固醇不是预后不良的危险因素。然而，高 MGFA 分级（优势比，102.6[4.4-2371.9]）患者发生严重 COVID-19 的风险增加。这些结果对于制定 COVID-19 大流行期间 MG 患者管理的循证指南非常重要。
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