Moreau T, Vukusic S, Vandenabeele S, Confavreux C
Service de Neurologie, Hôpital de l'Antiquaille, Lyon.
Rev Neurol (Paris). 1997 Mar;153(2):141-3.
We report a case of myasthenia gravis worsened by a nicotine transdermal system, in a man who usually was smoking fourty cigarettes per day without any worsening of his symptomatology. He noted an increased bilateral ptosis, total ophtalmoplegia, difficulty in chewing and generalized weakness two hours after application of a nicotine transdermal system, the symptoms improving after he removed it. Cholinergic receptors involved in myasthenia gravis are nicotinergic, and their number at the neuromuscular junction is reduced in myasthenia gravis. That leads to a "functional overdosage" after application of the nicotine transdermal system similar to the cholinergic crisis. This case can be compared with myasthenia syndromes described during the Second World War in tobacco chewers without any muscle impairment.
我们报告了一例重症肌无力患者，其症状因尼古丁透皮贴剂而加重。该男性患者通常每天吸40支烟，且症状无任何恶化。在使用尼古丁透皮贴剂两小时后，他注意到双侧上睑下垂加重、完全性眼肌麻痹、咀嚼困难和全身无力，取下贴剂后症状有所改善。重症肌无力所涉及的胆碱能受体是烟碱型的，在重症肌无力患者的神经肌肉接头处，其数量会减少。这导致在使用尼古丁透皮贴剂后出现类似于胆碱能危象的“功能性用药过量”。该病例可与第二次世界大战期间描述的咀嚼烟草者出现的重症肌无力综合征相比较，这些患者无任何肌肉损伤。
