Department of Neurology, Emory University, Atlanta, Georgia, USA.
Muscle Nerve. 2023 Aug;68(2):171-175. doi: 10.1002/mus.27919. Epub 2023 Jun 16.
INTRODUCTION/AIMS: Myasthenia gravis (MG) patients have been predicted to have high rates of coronavirus disease-2019 (COVID-19) complications due to frequent involvement of respiratory muscles in MG and frequent use of immunosuppressive therapies. We investigated outcomes of MG patients infected with SARS-CoV-2 to identify risk factors for exacerbation and severe disease.
This was a retrospective analysis of 39 MG patients with SARS-CoV-2 infection from January March 1, 2020 to October 25, 2021 at Emory University. Patients' records were queried for demographic data, MG history, and COVID-19 treatments and hospitalizations.
At the time of infection, 8 of 39 were vaccinated, 30 of 39 unvaccinated, and 1 unknown. Average age was 52.6 years. Twenty-seven patients were receiving immunomodulatory treatments at the time of infection. Thirty-five of 39 were symptomatic, 21 were hospitalized, and 7 required ventilations. MG exacerbations occurred in 5 and were treated with therapeutic plasma exchange (n = 1), intravenous immunoglobulin (IVIg) (n = 1), and prednisone taper (n = 5). Four hospitalized patients died from COVID-related lung injuries. No deaths were attributed to MG exacerbation; however, one patient receiving IVIg for MG exacerbation had a pulmonary embolism. There were no deaths in fully vaccinated patients, and only one vaccinated patient was admitted to the intensive care unit.
High rates of COVID-19 complications and death were observed in this cohort of MG patients. Some patients with MG and COVID-19 also had an exacerbation during infection. Further studies are needed to determine whether MG patients are at higher risk for complications than the rest of the population.
简介/目的：由于重症肌无力（MG）患者的呼吸肌经常受累，且经常使用免疫抑制疗法，因此预测他们 COVID-19 并发症的发生率较高。我们研究了感染 SARS-CoV-2 的 MG 患者的结局，以确定加重和重症疾病的危险因素。
这是对 2020 年 1 月 1 日至 2021 年 10 月 25 日期间在埃默里大学感染 SARS-CoV-2 的 39 名 MG 患者的回顾性分析。对患者的记录进行了检索，以获取人口统计学数据、MG 病史以及 COVID-19 的治疗和住院情况。
在感染时，8 例已接种疫苗，30 例未接种疫苗，1 例情况未知。平均年龄为 52.6 岁。27 例患者在感染时正在接受免疫调节治疗。39 例患者中有 35 例出现症状，21 例住院，7 例需要通气。5 例发生 MG 加重，其中 1 例接受了治疗性血浆置换（n = 1），1 例接受了静脉注射免疫球蛋白（IVIg）（n = 1），5 例接受了泼尼松减量。4 例住院患者死于 COVID 相关肺损伤。没有死亡归因于 MG 加重；然而，1 例接受 IVIg 治疗 MG 加重的患者发生了肺栓塞。完全接种疫苗的患者无一例死亡，仅 1 例接种疫苗的患者入住重症监护病房。
在这组 MG 患者中观察到 COVID-19 并发症和死亡的发生率较高。一些患有 MG 和 COVID-19 的患者在感染期间也出现了加重。需要进一步的研究来确定 MG 患者是否比其他人群更容易发生并发症。
