Aging and infectious diseases in myasthenia gravis

IF 3.6 3区 医学 Q1 CLINICAL NEUROLOGY Journal of the Neurological Sciences Pub Date : 2025-01-15 DOI:10.1016/j.jns.2024.123314
Vera Bril , Nils Erik Gilhus
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Abstract

Over the past 120 years, mortality associated with myasthenia gravis (MG) has steadily decreased while the incidence of MG has increased. While mortality due to MG has been ≤5 % for at least the past 25 years, the prevalence of MG has increased. This increase in prevalence of MG may be due, in part, to improvements in diagnostics but also to an aging global population and immunosenescence as the largest increases in MG prevalence have been in patients ≥65 years old.
In fact, a “very late-onset” subtype of MG has been proposed for patients diagnosed at or after age 65 years. These patients are predominantly anti-AChR antibody positive and thymoma negative. Preferred therapeutic options differ based on age at MG onset. Immunosenescence may play a role not only in MG etiology but also in the increased susceptibility of MG patients to infection. Immunosuppressive effects of MG therapies can also increase vulnerability to infection. Despite the improvements in MG treatment, mortality in MG patients remains higher than in the non-MG population. This is partly due to increased vulnerability to infection but also due to infection acting as a precipitating factor for MG exacerbation or crisis.
The increased infection risk inherent with MG and the increased risk resulting from some therapies calls for increased diligence in monitoring and treating infections in MG patients.
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重症肌无力症的衰老和传染性疾病。
在过去的120年里,与重症肌无力(MG)相关的死亡率稳步下降,而MG的发病率却在增加。虽然至少在过去25年中,MG的死亡率≤5%,但MG的患病率有所增加。MG患病率增加的部分原因可能是诊断方法的改进,但也可能是由于全球人口老龄化和免疫衰老,因为MG患病率增加最多的是≥65岁的患者。事实上,对于65岁或65岁以后诊断的MG患者,已经提出了一种“非常晚发”亚型。这些患者主要是抗achr抗体阳性,胸腺瘤阴性。MG发病年龄不同,首选治疗方案也不同。免疫衰老可能不仅在MG病因学中起作用,而且在MG患者对感染的易感性增加中起作用。MG疗法的免疫抑制作用也会增加对感染的易感性。尽管MG治疗有所改善,MG患者的死亡率仍然高于非MG人群。这部分是由于对感染的脆弱性增加,但也是由于感染是MG恶化或危机的促成因素。MG固有的感染风险增加,以及一些治疗方法导致的风险增加,要求对MG患者的感染进行更严格的监测和治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of the Neurological Sciences
Journal of the Neurological Sciences 医学-临床神经学
CiteScore
7.60
自引率
2.30%
发文量
313
审稿时长
22 days
期刊介绍: The Journal of the Neurological Sciences provides a medium for the prompt publication of original articles in neurology and neuroscience from around the world. JNS places special emphasis on articles that: 1) provide guidance to clinicians around the world (Best Practices, Global Neurology); 2) report cutting-edge science related to neurology (Basic and Translational Sciences); 3) educate readers about relevant and practical clinical outcomes in neurology (Outcomes Research); and 4) summarize or editorialize the current state of the literature (Reviews, Commentaries, and Editorials). JNS accepts most types of manuscripts for consideration including original research papers, short communications, reviews, book reviews, letters to the Editor, opinions and editorials. Topics considered will be from neurology-related fields that are of interest to practicing physicians around the world. Examples include neuromuscular diseases, demyelination, atrophies, dementia, neoplasms, infections, epilepsies, disturbances of consciousness, stroke and cerebral circulation, growth and development, plasticity and intermediary metabolism.
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