乙酰胆碱受体抗体及兰尼碱受体抗体双阳性新生儿短暂性重症肌无力1例

目的 探讨乙酰胆碱受体（AChR）抗体和兰尼碱受体（RyR）抗体双抗体阳性新生儿短暂性重症肌无力（TNMG）病儿的临床特点、诊疗和预后。方法 回顾性分析南京医科大学附属连云港医院2021年3月收治的1例AChR与RyR双抗体阳性TNMG的临床资料,并复习相关文献,为早期识别提供临床思路。结果 男,30 min,因“气促、呻吟30 min”入院,入院第2天出现呼吸困难逐渐加重,提高氧饱和度仍不能维持在正常范围,自行进奶差,吸吮能力差,偶有吐奶,哭声低。新斯的明试验阳性,神经肌肉疾病检测提示AChR抗体和RyR抗体阳性,其母有3年重症肌无力病史。予气管插管机械通气,鼻饲奶喂养,溴吡斯的明片口服等治疗15 d,病儿病情好转出院,出院后门诊随访至3个月,病儿吃奶好,智力及体格发育在正常范围。结论重症肌无力母亲分娩的新生儿均应转入新生儿重症监护室密切监护,且有TNMG病史的婴儿应长期随访。

A case of neonatal transient myasthenia gravis with double-positive acetylcholine receptor antibody and ryanodine receptor antibody

Objective To investigate the clinical characteristics, diagnosis, and prognosis of infants with double antibody-positiveneonatal transient myasthenia gravis (TNMG) with acetylcholine receptor (AChR) antibody and ranibulin receptor (RyR) antibody.Methods The clinical data of a case of TNMG positive for AChR and RyR double antibodies admitted to Lianyungang Hospital affili-ated to Nanjing Medical University in March 2021 were retrospectively analyzed, and the relevant literature was reviewed to provideclinical ideas for early identification.Results A 30-min male baby was admitted with "shortness of breath and moaning for 30 min".On the second day of admission, he presented with progressively worsening respiratory distress, failure to maintain oxygen saturation inthe normal range even after raising oxygen saturation, poor self-feeding, poor sucking ability, occasional vomiting, and low crying. Theneostigmine test was positive, and the neuromuscular disease test was positive for AChR and RyR antibodies. His mother had a 3-yearhistory of myasthenia gravis. The child was discharged from the hospital after 15 d of treatment with mechanical ventilation by trachealintubation, intranasal milk feeding, and oral administration of bromipyridamole tablets and was followed up in the outpatient clinic until3 months of age. The patient was well fed with milk, and her intelligence and physical development were in the normal range.Conclu. sion All newborns delivered by mothers with myasthenia gravis should be transferred to the neonatal intensive care unit for close mon-itoring, and infants with a history of TNMG should be followed up for a long time.