重症肌无力合并系统性红斑狼疮4例并文献复习  

Four cases of myasthenia gravis combined with systemic lupus erythematosus and literature review

作　　者：刘肇绩[1] 董佳萌 黄榕 吴紫微 彭锋[1] 郑晓龄 LIU Zhaoji;DONG Jiameng;HUANG Rong;WU Ziwei;PENG Feng;ZHENG Xiaoling(Department of Neurology,Zhongshan Hospital Affiliated to Xiamen University,Fujian Province,Xiamen361004,China;the Third Clinical Medical College,Fujian Medical University,Fujian Province,Xiamen361004,China)

机构地区：[1]厦门大学附属中山医院神经内科,福建厦门361004 [2]福建医科大学第三临床医学院,福建厦门361004

出　　处：《中国医药导报》2024年第35期183-186,共4页China Medical Herald

基　　金：福建省自然科学基金资助项目(2021J011339);厦门市医疗卫生指导性项目(35022202242D1042)。

摘　　要：重症肌无力(MG)和系统性红斑狼疮(SLE)均为自身免疫性疾病,两者均好发于女性、症状波动、常合并抗核抗体阳性和胸腺增生,但两者的共病关联特点尚未明确。本文报道厦门大学附属中山医院收治的4例MG合并SLE病例,均为女性,SLE经羟氯喹治疗后出现全身型MG,早期易误诊,预后差,2例肌无力危象,2例复发,1例死亡。激素联合其他免疫抑制药物治疗有效。结合文献分析,特别对胸腺切除术MG患者,动态观察有无合并多系统脏器损坏的可能,必要时观察皮疹、关节疼痛临床表现和血清学排除SLE。对SLE并发肢体乏力、言语含糊等症状,完善抗乙酰胆碱受体抗体检测、重频试验等,以确认或排除MG,密切关注病情演变,早期干预和早期治疗,防治预后不佳的可能。Myasthenia gravis(MG)and systemic lupus erythematosus(SLE)are both autoimmune diseases that are more common in women,have fluctuating symptoms,and are often accompanied by positive antinuclear antibody and thymic hyperplasia.However,the comorbidity characteristics of the two are not yet clear.This article reports four cases of MG combined with SLE admitted to Zhongshan Hospital Affiliated to Xiamen University,all of whom are female.systemic MG appeared after treatment with Hydroxychloroquine in SLE,which is easily misdiagnosed in the early stage,and had a poor prognosis.There are two cases of myasthenia crisis,two cases of recurrence,and one case of death.Hormone combined with other immunosuppressive drugs is effective in treatment.Based on literature analysis,especially for MG patients undergoing thymectomy,dynamically observe the possibility of multiple system organ damage,and if necessary,observe clinical manifestations of rash,joint pain,and serological exclusion of SLE.To address symptoms such as limb weakness,and slurred speech in SLE,it is necessary to improve anti acetylcholine receptor antibody testing,repeat frequency testing,etc.to confirm or exclude MG,closely monitor the progression of the disease,early intervention,and early treatment,and prevent and treat the possibility of poor prognosis.

关 键 词：重症肌无力 系统性红斑狼疮 自身免疫性疾病 预后 

分 类 号：R593.24[医药卫生—内科学]