Crisis miasténica, diagnóstico y tratamiento

IF 0.4 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes Pub Date : 2025-05-01 DOI:10.1016/j.rmclc.2025.06.003

Luis Gutiérrez Panchana MD , Luis Pedraza Castillo MD

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Abstract

Myasthenic crisis (MC) is a severe and potentially fatal complication of autoimmune myasthenia gravis (MG), characterized by an acute worsening of bulbar and respiratory muscle weakness that can lead to respiratory failure. It may occur in up to 20% of patients with MG, and in some cases constitutes the initial manifestation of the disease. Early recognition and early intervention are key to improving prognosis.

MC requires urgent, multidisciplinary management. Early respiratory support, immunotherapy with IVIG or PLEX, and appropriate use of immunosuppressants are critical for good outcomes. Current research on biologic therapies offers new alternatives for patients with refractory disease.

This article aims to comment on the current evidence and provide a comprehensive overview of the clinical features, diagnostic approach, triggering factors and therapeutic strategies in the management of MC, synthesizing pathophysiological mechanisms, ICU management protocols, immunotherapeutic interventions and new biologic therapies.

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肌无力危机的诊断和治疗

重症肌无力危象（MC）是自身免疫性重症肌无力（MG）的一种严重且可能致命的并发症，其特征是球肌和呼吸肌无力的急性恶化，可导致呼吸衰竭。它可能发生在高达20%的MG患者中，并且在某些情况下构成该疾病的初始表现。早期识别和早期干预是改善预后的关键。MC需要紧急的多学科管理。早期呼吸支持、IVIG或PLEX免疫治疗以及适当使用免疫抑制剂是获得良好结果的关键。目前生物疗法的研究为难治性疾病患者提供了新的选择。本文旨在对目前的证据进行评述，并对MC的临床特点、诊断方法、触发因素和治疗策略、综合病理生理机制、ICU管理方案、免疫治疗干预和新的生物治疗方法进行全面综述。

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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