重症肌无力特异性细胞免疫应答与鼻黏膜耐受疗效的分析  

Analysis of relationship between specific cell-mediated immune response and therapeutic efficacy of nasal tolerance in the myasthenia gravis

作　　者：王丽华[1] 赵含丹[2] 刘式威[1] 么秋香[1] 王维治[3] 

机构地区：[1]中国人民解放军211医院,黑龙江哈尔滨150080 [2]中国人民解放军沈阳军区大连第二疗养院 [3]哈尔滨医科大学附属二院神经内科,黑龙江哈尔滨150086

出　　处：《中国急救医学》2004年第7期492-493,共2页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金资助项目 ( 3 9970 2 62 )

摘　　要：目的　探讨重症肌无力 (MG)的特异性细胞免疫异常应答及双类似物鼻黏膜免疫耐受疗效。方法　检测MG患者和健康对照者的外周血中单个核细胞中CD4 + 及CD4 + CD2 5 + T细胞 ;检测IFN -γ、IL - 4及IL - 10分泌细胞含量 ,并对病情的严重程度和转归进行评定。结果　MG组鼻黏膜耐受治疗前IFN -γ、IL - 4及IL - 10阳性细胞含量均明显高于各自健康对照组 (P均 <0 .0 1) ,治疗后明显低于治疗前 ,但与各自的对照组无明显差异 (P均 >0 .0 5 ) ;CD4 + T淋巴细胞与对照组比较无明显差异 ,耐受治疗后较治疗前降低 ,但无显著差异 (P均 >0 .0 5 ) ;其亚群CD4 + CD2 5 + T细胞耐受治疗前明显低于对照组 ,治疗后明显高于治疗前及对照组 (P均 <0 .0 1) ;而CD4 + CD2 5 -T细胞治疗前明显高于对照组 ,耐受治疗后明显低于治疗前(P <0 .0 1)。结论　MG患者体内存在特异性细胞免疫活化和细胞因子网络的失衡 ,外周血中单个核细胞的免疫参数可反映MG患者的免疫学改变 ,提示MG存在免疫功能的紊乱 ,符合自身免疫病的特点 ;Objective To investigate the specific cell-mediated immune response and the therapeutic efficacy of nasal tolerance with a dual analogue (Lys262-Ala207) in the patients with myasthenia gravis (MG). Methods The numbers of mononuclear cells (MNC) expressing CD4 and/or CD25 and MNC expressing IFN-γ,IL-4 or IL-10 from peripheral blood were enumerated by flow cytometry in 39 MG patients before and after treatment with Lys262-Ala207 and in healthy controls. The clinical severity and prognosis of MG were evaluated by Xu′s clinical scoring system. Results The cells of synthesizing IFN-γ, IL-4 or IL-10 were higher before treatment and lower after treatment, whereas the numbers of CD4 +CD25 +T cells were lower before treatment and higher after treatment in group MG than in their corresponding control groups. The clinical efficiency of Lys262-Ala207 treatment was 79.48% (in 31 MG patients). Conclusions There was an activation of specific cell-mediated immunity and an imbalance of cytokines from Th1 and Th2 in MG patients. Our results might reflect the disturbance of immunological function in patients with MG. It was consistent with the characteristics of autoimmune diseases. Some immune parameters in PBMC might reflect the immune alteration in PBMC from MG patients. Nasal administration with a dual analogue Lys262-Ala207 not only suppressed function of T cell but also played an important role in the treatment of MG patients.[

关 键 词：重症肌无力 IFN-γ IL-4 IL-10 CD4^+ CD25^+T细胞 鼻黏膜耐受 

分 类 号：R746.1[医药卫生—神经病学与精神病学]