Bronchial obstruction in patients with generalized myasthenia gravis
Aim. To study the presence of bronchial obstruction in patients with generalized myasthenia gravis, its relation with respiratory symptoms and structural changes in the lower respiratory tract and lungs according to multispiral computed tomography of the lungs and external respiratory function. Materials and methods. 32 patients with MA and 30 patients without myasthenia gravis and chronic lung and bronchial diseases were analyzed. General clinical examination, ERF examination, and multispiral computed tomography of the lungs were performed in 15 patients with myasthenia gravis. Results. Structural changes in the bronchi were observed in 14 (95%) people, генерализованная obstruction of the lower respiratory tract - in 13 (86.6%) patients. The presence of patency of the lower respiratory tract was characterized by thickening, compaction, and uneven lumen of the visible bronchi. Structural changes of the lower respiratory tract with changes in the lungs were detected in 12 (80%) patients and were associated with deformation in the form of a grid pattern, or frosted glass, the presence of fibrous, pneumosclerotic foci, pleural adhesions. An increase in lung airiness in the form of emphysema, emphysematous bullae and cysts was observed in 13 (86.6%) patients. On the external respiratory function examination in patients with myasthenia, a picture of a mixed restrictive-obstructive variant of violation of ventilation function of the lungs was noted. Conclusion. Despite the fact that the most common in the clinical picture of generalized myasthenia gravis is a severe course of craniobulbar syndrome, the prognosis of the disease and the fate of patients are often determined by extra-myasthenic conditions. Among the latter, lung and lower respiratory tract lesions, which have a direct prognostic value, are of great interest. The literature on this subject is sparse and contradictory. Clarification of the variant of changes in the ventilation function of the lungs will allow optimizing the diagnostic algorithm for primary and dynamic observation in patients with myasthenia. Respiratory function monitoring, which will allow to determine the reversibility or absence of obstructive syndrome, is important.