Bi Zhuajin, Gao Huajie, Lin Jing, Gui Mengcui, Li Yue, Li Zhijun, Bu Bitao
Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
J Inflamm Res. 2024 Aug 29;17:5807-5820. doi: 10.2147/JIR.S475729. eCollection 2024.
To investigate the predictors for poor outcomes (including disease exacerbation, hospitalization and myasthenic crisis) in patients with pre-existing myasthenia gravis (MG) following Coronavirus disease 2019 (COVID-19), and to explore the potential effects of COVID-19 on inflammatory and immune responses in MG patients.
This retrospective cohort study analyzed medical records of 845 MG patients who were diagnosed with COVID-19 between January 2020 to March 2023 at a single medical center.
Generalized MG at onset and comorbidities (chronic kidney disease and malignancy) were independent risk factors of poor outcomes. Patients achieving minimal manifestation or better status before COVID-19 had a significantly reduced risk for poor outcomes. Furthermore, patients with older onset age or anti-acetylcholine receptor antibody had a higher risk of exacerbation and hospitalization than those without. Prednisone or immunosuppressant treatment had the potential to reduce the occurrence of poor outcomes, while the duration of prednisone or immunosuppressant usage was associated with a higher risk of poor outcomes. Of the 376 MG patients with blood results available, patients with COVID-19 tended to have higher levels of leukocyte counts, neutrophil-lymphocyte-ratio, hypersensitive C-reactive protein, and Interleukin-6, as well as lower percentages of lymphocytes and regulatory T cells compared to patients without COVID-19.
Disease severity at onset, comorbidities, and unsatisfactory control of myasthenic symptoms predicted the occurrence of poor outcomes in MG patients following COVID-19. The risk of poor outcomes was reduced in patients controlled by short-term immunosuppressive therapy. Novel coronavirus might affect inflammatory and immune responses in MG patients, particularly in altering interleukin-6 and regulatory T cell levels.
研究既往患有重症肌无力（MG）的患者在感染2019冠状病毒病（COVID-19）后预后不良（包括疾病加重、住院和重症肌无力危象）的预测因素，并探讨COVID-19对MG患者炎症和免疫反应的潜在影响。
这项回顾性队列研究分析了2020年1月至2023年3月在单一医疗中心被诊断为COVID-19的845例MG患者的病历。
发病时的全身型MG和合并症（慢性肾脏病和恶性肿瘤）是预后不良的独立危险因素。在COVID-19之前达到最小表现或更好状态的患者预后不良的风险显著降低。此外，发病年龄较大或有抗乙酰胆碱受体抗体的患者比没有这些情况的患者有更高的病情加重和住院风险。泼尼松或免疫抑制剂治疗有可能降低预后不良的发生率，而泼尼松或免疫抑制剂的使用时间与预后不良风险较高有关。在376例有血液检查结果的MG患者中，与未感染COVID-19的患者相比，感染COVID-19的患者白细胞计数、中性粒细胞与淋巴细胞比值、超敏C反应蛋白和白细胞介素-6水平往往更高，而淋巴细胞和调节性T细胞百分比更低。
发病时的疾病严重程度、合并症以及重症肌无力症状控制不佳可预测MG患者感染COVID-19后预后不良的发生。短期免疫抑制治疗控制的患者预后不良风险降低。新型冠状病毒可能会影响MG患者的炎症和免疫反应，特别是在改变白细胞介素-6和调节性T细胞水平方面。
