Liu Peng, Li Mengna, Li Liqing, Jia Wenli, Dong Huimin, Qi Guoyan
Center of Treatment of Myasthenia Gravis, People's Hospital of Shijiazhuang, Shijiazhuang, China.
Hebei Provincial Key Laboratory of Myasthenia Gravis, Shijiazhuang, China.
Front Neurol. 2024 Dec 11;15:1482932. doi: 10.3389/fneur.2024.1482932. eCollection 2024.
Myasthenia gravis (MG) is characterized by fluctuating muscle weakness due to immune-mediated damage to acetylcholine receptors. Viral infections can exacerbate symptoms of muscle weakness, and the clinical status of patients with MG may influence the outcomes of such infections. Here, we identified factors of symptom exacerbation, severe SARS-CoV-2 infection, and pneumonia in patients with MG who are infected with SARS-CoV-2.
The clinical characteristics and outcomes of 341 MG patients infected with SARS-CoV-2 across multiple regions in China were determined.
The median age of the patients was 49 years (range: 35-60 years) and the median disease duration was 4 years (range: 2-8 years). Among the patients, 67 (49.0%) were male and 174 (51.0%) were female. Multivariate analysis indicated that thymectomy [OR, 1.654 (95% CI, 1.036-2.643); = 0.035], severe SARS-CoV-2 infection [OR, 4.275 (95% CI, 2.206-8.286); < 0.001], and pyridostigmine bromide [OR, 1.955 (95% CI, 1.192-3.206); = 0.008] were associated with exacerbation of MG symptoms in patients infected with SARS-CoV-2. Age was significantly associated with severe SARS-CoV-2 infection [OR, 1.023 (95% CI, 1.001-1.046); = 0.008], while patients with cardiac/vascular comorbidities exhibited an increased likelihood of severe SARS-CoV-2 infection [OR, 3.276 (95% CI, 1.027-10.449); = 0.045]. Likewise, steroid treatment [OR, 6.140 (95% CI, 2.335-16.140); < 0.001] was associated with a significantly increased likelihood of severe SARS-CoV-2 infection compared with symptomatic treatment. Additionally, gender [OR, 0.323 (95% CI, 0.120-0.868); = 0.025] and SARS-CoV-2 severity [OR, 6.067 (95% CI, 1.953-18.850); = 0.002] were associated with the occurrence of pneumonia.
We identified factors that were associated with the exacerbation of MG symptoms in patients infected with SARS-CoV-2, including thymectomy, severe SARS-CoV-2 infection, and the use of pyridostigmine bromide. Due to the retrospective nature of the study, these findings should be interpreted as associations rather than predictive factors. However, the results confirm the established relationships between severe SARS-CoV-2 infection and age, cardiovascular comorbidities, and the use of steroid treatment, suggesting that these factors should be considered when managing MG patients during SARS-CoV-2 infection.
重症肌无力（MG）的特征是由于乙酰胆碱受体受到免疫介导的损伤而导致肌肉无力波动。病毒感染可使肌肉无力症状加重，MG患者的临床状况可能会影响此类感染的结局。在此，我们确定了感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的MG患者症状加重、严重SARS-CoV-2感染和肺炎的相关因素。
确定了中国多个地区341例感染SARS-CoV-2的MG患者的临床特征和结局。
患者的中位年龄为49岁（范围：35 - 60岁），中位病程为4年（范围：2 - 8年）。患者中，67例（49.0%）为男性，174例（51.0%）为女性。多因素分析表明，胸腺切除术[比值比（OR），1.654（95%置信区间，1.036 - 2.643）；P = 0.035]、严重SARS-CoV-2感染[OR，4.275（95%置信区间，2.206 - 8.286）；P < 0.001]和溴吡斯的明[OR，1.955（95%置信区间，1.192 - 3.206）；P = 0.008]与感染SARS-CoV-2的患者MG症状加重相关。年龄与严重SARS-CoV-2感染显著相关[OR，1.023（95%置信区间，1.001 - 1.046）；P = 0.008]，而患有心脏/血管合并症的患者发生严重SARS-CoV-2感染的可能性增加[OR，3.276（95%置信区间，1.027 - 10.449）；P = 0.045]。同样，与对症治疗相比，类固醇治疗[OR，6.140（95%置信区间，2.335 - 16.140）；P < 0.001]与严重SARS-CoV-2感染的可能性显著增加相关。此外，性别[OR，0.323（95%置信区间，0.120 - 0.868）；P = 0.025]和SARS-CoV-2严重程度[OR，6.067（95%置信区间，1.953 - 18.850）；P = 0.002]与肺炎的发生相关。
我们确定了与感染SARS-CoV-2的患者MG症状加重相关的因素，包括胸腺切除术、严重SARS-CoV-2感染和溴吡斯的明的使用。由于本研究的回顾性性质，这些发现应解释为关联而非预测因素。然而，结果证实了严重SARS-CoV-2感染与年龄、心血管合并症以及类固醇治疗使用之间已确立的关系，表明在SARS-CoV-2感染期间管理MG患者时应考虑这些因素。
