PDF(Pubmed)
Abstract：
BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, patients with myasthenia gravis (MG) were more susceptible to poor outcomes owing to respiratory muscle weakness and immunotherapy. Several studies conducted in the early stages of the COVID-19 pandemic reported higher mortality in patients with MG compared to the general population. This study aimed to investigate the clinical course and prognosis of COVID-19 in patients with MG and to compare these parameters between vaccinated and unvaccinated patients in South Korea.
METHODS: This multicenter, retrospective study, which was conducted at 14 tertiary hospitals in South Korea, reviewed the medical records and identified MG patients who contracted COVID-19 between February 2022 and April 2022. The demographic and clinical characteristics associated with MG and vaccination status were collected. The clinical outcomes of COVID-19 infection and MG were investigated and compared between the vaccinated and unvaccinated patients.
RESULTS: Ninety-two patients with MG contracted COVID-19 during the study. Nine (9.8%) patients required hospitalization, 4 (4.3%) of whom were admitted to the intensive care unit. Seventy-five of 92 patients were vaccinated before contracting COVID-19 infection, and 17 were not. During the COVID-19 infection, 6 of 17 (35.3%) unvaccinated patients were hospitalized, whereas 3 of 75 (4.0%) vaccinated patients were hospitalized (P < 0.001). The frequencies of ICU admission and mechanical ventilation were significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.019 and P = 0.032, respectively). The rate of MG deterioration was significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.041). Logistic regression after weighting revealed that the risk of hospitalization and MG deterioration after COVID-19 infection was significantly lower in the vaccinated patients than in the unvaccinated patients.
CONCLUSIONS: This study suggests that the clinical course and prognosis of patients with MG who contracted COVID-19 during the dominance of the omicron variant of COVID-19 may be milder than those at the early phase of the COVID-19 pandemic when vaccination was unavailable. Vaccination may reduce the morbidity of COVID-19 in patients with MG and effectively prevent MG deterioration induced by COVID-19 infection.
METHODS: This multicenter, retrospective study, which was conducted at 14 tertiary hospitals in South Korea, reviewed the medical records and identified MG patients who contracted COVID-19 between February 2022 and April 2022. The demographic and clinical characteristics associated with MG and vaccination status were collected. The clinical outcomes of COVID-19 infection and MG were investigated and compared between the vaccinated and unvaccinated patients.
RESULTS: Ninety-two patients with MG contracted COVID-19 during the study. Nine (9.8%) patients required hospitalization, 4 (4.3%) of whom were admitted to the intensive care unit. Seventy-five of 92 patients were vaccinated before contracting COVID-19 infection, and 17 were not. During the COVID-19 infection, 6 of 17 (35.3%) unvaccinated patients were hospitalized, whereas 3 of 75 (4.0%) vaccinated patients were hospitalized (P < 0.001). The frequencies of ICU admission and mechanical ventilation were significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.019 and P = 0.032, respectively). The rate of MG deterioration was significantly lower in the vaccinated patients than in the unvaccinated patients (P = 0.041). Logistic regression after weighting revealed that the risk of hospitalization and MG deterioration after COVID-19 infection was significantly lower in the vaccinated patients than in the unvaccinated patients.
CONCLUSIONS: This study suggests that the clinical course and prognosis of patients with MG who contracted COVID-19 during the dominance of the omicron variant of COVID-19 may be milder than those at the early phase of the COVID-19 pandemic when vaccination was unavailable. Vaccination may reduce the morbidity of COVID-19 in patients with MG and effectively prevent MG deterioration induced by COVID-19 infection.
摘要：
背景：在2019年冠状病毒病（COVID-19）大流行期间，重症肌无力(MG)患者由于呼吸肌无力和免疫治疗更容易出现不良结局.在COVID-19大流行的早期阶段进行的几项研究报告，与普通人群相比，MG患者的死亡率更高。本研究旨在调查COVID-19在MG患者中的临床病程和预后，并比较韩国接种疫苗和未接种疫苗的患者之间的这些参数。
方法：这个多中心，回顾性研究,在韩国的14家三级医院进行，审查了医疗记录，确定了2022年2月至2022年4月期间感染COVID-19的MG患者。收集与MG和疫苗接种状态相关的人口统计学和临床特征。在接种疫苗和未接种疫苗的患者之间调查并比较了COVID-19感染和MG的临床结果。
结果：92例MG患者在研究期间感染了COVID-19。九名(9.8%)病人需要住院治疗,其中4人(4.3%)被送进重症监护室。92名患者中有75名在感染COVID-19之前接种了疫苗，17不是。在COVID-19感染期间，17名未接种疫苗的患者中有6人(35.3%)住院，75例接种疫苗的患者中有3例（4.0％）住院（P<0.001）。接种疫苗的患者ICU入院和机械通气的频率明显低于未接种疫苗的患者（分别为P=0.019和P=0.032）。接种疫苗的患者的MG恶化率显著低于未接种疫苗的患者(P=0.041)。加权后的Logistic回归显示，接种疫苗的患者在感染COVID-19后住院和MG恶化的风险明显低于未接种疫苗的患者。
结论：这项研究表明，在COVID-19的omicron变体占主导地位期间感染COVID-19的MG患者的临床病程和预后可能比在无法接种疫苗的COVID-19大流行早期阶段的患者要温和。接种疫苗可降低MG患者COVID-19的发病率，有效预防COVID-19感染引起的MG恶化。
方法：这个多中心，回顾性研究,在韩国的14家三级医院进行，审查了医疗记录，确定了2022年2月至2022年4月期间感染COVID-19的MG患者。收集与MG和疫苗接种状态相关的人口统计学和临床特征。在接种疫苗和未接种疫苗的患者之间调查并比较了COVID-19感染和MG的临床结果。
结果：92例MG患者在研究期间感染了COVID-19。九名(9.8%)病人需要住院治疗,其中4人(4.3%)被送进重症监护室。92名患者中有75名在感染COVID-19之前接种了疫苗，17不是。在COVID-19感染期间，17名未接种疫苗的患者中有6人(35.3%)住院，75例接种疫苗的患者中有3例（4.0％）住院（P<0.001）。接种疫苗的患者ICU入院和机械通气的频率明显低于未接种疫苗的患者（分别为P=0.019和P=0.032）。接种疫苗的患者的MG恶化率显著低于未接种疫苗的患者(P=0.041)。加权后的Logistic回归显示，接种疫苗的患者在感染COVID-19后住院和MG恶化的风险明显低于未接种疫苗的患者。
结论：这项研究表明，在COVID-19的omicron变体占主导地位期间感染COVID-19的MG患者的临床病程和预后可能比在无法接种疫苗的COVID-19大流行早期阶段的患者要温和。接种疫苗可降低MG患者COVID-19的发病率，有效预防COVID-19感染引起的MG恶化。
