重症肌无力合并新型冠状病毒肺炎(附1例报告及文献复习)

Myasthenia Gravis with COVID-19:One Case Report and Literature Review

目的探讨重症肌无力(MG)合并新型冠状病毒肺炎(COVID-19)患者的临床特征及不同免疫治疗策略对预后的影响。方法收集1例MG合并COVID-19感染患者的临床资料及诊治经过,通过互联网检索国内外数据库,回顾既往文献报道的34例MG合并COVID-19感染病例进行讨论。结果患者为中国籍老年男性,68岁。入院后立即予以呼吸支持,神经科肌力查体无法配合,停用吗替麦考酚酯。治疗1周后COVID-19症状好转,恢复吗替麦考酚酯治疗,1个月后症状进一步好转,停用呼吸机,MG症状稳定后出院。国内文献未检索到相关病例报道,PubMed数据库共检索到11篇文献共计34例MG合并COVID-19病例报道,相关队列研究文献2篇。结合文献病例分析,使用非激素类免疫抑制剂(IS)患者(18例,使用非激素类IS组)与未使用免疫抑制剂患者(17例,未使用非激素类IS组)的性别、年龄、发病时美国重症肌无力基金会(MGFA)分型及其他治疗药物均未见差异有显著性,但使用非激素类IS组的死亡病例(0例)明显低于未使用非激素类IS组(4例),差异有统计学意义(P=0.046)。结论MG合并COVID-19患者病情严重,预后相对较差,MG严重程度(MGFA分型Ⅴ和Ⅵ)是影响患者预后的独立危险因素。研究提示MG患者感染COVID-19期间继续使用激素和IS并不增加重症和死亡风险,大多数患者可以维持原有的免疫治疗方案。

Aim Aim To investigate the clinical features of myasthenia gravis(MG)patients with coronavirus disease-19(COVID-19)and effect of different immunotherapy regimens on the prognosis.Methods A case of MG with COVID-19 was reported and 34 cases of MG with COVID-19 reported previously were reviewed through medical literature databases.Results The Chinese elderly male patient received respiratory support instantly after admission mycophenolate mofetil(MMF)discontinued,but was unable to cooperate with neurological examination.After the treatment for a month,the patient showed improvement in the symptoms of COVID-19 and discontinued respiratory support.No relevant report was retrieved in domestic literature databases.Eleven papers were retrieved in Pub Med with 34 cases reported in detail.Another 2 papers with relevant cohort study were also retrieved.There were no significant difference in sex,age,classification of Myasthenia Gravis Foundation of America(MGFA)after infection and other drugs administered between the patients who received nonsteroidal immunosuppressant(IS)and the patients who did not,further comparison showed significantly lower mortality in patients who received IS than patients who did not(P=0.046).Conclusion MG with COVID-19 showed higher severity and worse prognosis.The severity of MG(MGFAⅤandⅥ)might independently be a risk factor for the prognosis of MG with COVID-19.Our study indicated that continuous administration of steroid and IS in patients with COVID-19 did not add to the risk of critical illness or death.Most of the patients did not need to change their regimens.