Akiba Y, Takeuchi T, Nakanishi K, Inoue H, Fujiuchi S, Osanai S, Nakano H, Osaki Y, Yahara O, Kikuchi K
First Department of Internal Medicine, Asahikawa Medical Colleges, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Apr;34(4):449-53.
A 52-year-old woman had a 14-year history of stridor attacks. Pulmonary function tests revealed reversible airway obstruction, and bronchial asthma was diagnosed. She also has bilateral ptosis, diplopia, and moderate weakness of all four limbs; a positive edrophonium test confirmed the diagnosis of myasthenia gravis. Although the parasympathetic system plays an important role in the regulation of bronchial tone, in this patient the edrophonium test did not provoke an asthmatic attack or exacerbate pulmonary function, except for increases in sputum production and in frequency of cough. The general weakness was usually worse in the afternoon. The decrease in grip strength and the shortening of arm elevation time also occurred after asthma attacks, which means that general muscle fatigue was caused by the work of breathing. Furthermore, dyspnea increased and pulmonary function worsened when an anti-cholinesterase inhibitor was discontinued, probably because of respiratory muscle weakness. Accordingly, the clinical status of bronchial asthma seemed to change in parallel with that of the myasthenia gravis.
一名52岁女性有14年喘鸣发作史。肺功能测试显示可逆性气道阻塞，诊断为支气管哮喘。她还出现双侧上睑下垂、复视以及四肢中度无力；依酚氯铵试验阳性确诊为重症肌无力。尽管副交感神经系统在支气管张力调节中起重要作用，但在该患者中，依酚氯铵试验除了使痰液分泌增加和咳嗽频率增加外，并未引发哮喘发作或使肺功能恶化。全身无力通常在下午加重。握力下降和手臂抬高时间缩短也发生在哮喘发作之后，这意味着呼吸做功导致了全身肌肉疲劳。此外，停用抗胆碱酯酶抑制剂时，呼吸困难加重且肺功能恶化，可能是由于呼吸肌无力。因此，支气管哮喘的临床状况似乎与重症肌无力的状况平行变化。
