重症肌无力患者免疫指标检测及其临床评价  

Clinical value of the immune parameters in patients with myasthenia gravis

作　　者：刘卫彬[1] 门丽娜[2] 夏强[1] 何雪桃[1] 黄如训[1] 

机构地区：[1]广州中山大学附属第一医院神经内科,510080 [2]深圳市儿童医院神经内科

出　　处：《中华医学杂志》2006年第47期3331-3334,共4页National Medical Journal of China

基　　金：广东省科委重点基金资助项目(102016;133017)

摘　　要：目的探讨重症肌无力(MG)患者的免疫指标与病情、分类及疗效之间的关系,评价其临床意义。方法在治疗前后动态采用流式细胞仪检测外周血CD3、CD4和CD8及比浊法检测IgG、IgA和IgM,进行分类比较其变化。结果全身型MG患者的IgG、IgA较眼肌型高,P<0.05,差异有统计学意义。在体液免疫低下组中,用丙种球蛋白治疗的缓解率为95.2%,仅用吡啶斯的明组缓解率为28.8%,二者比较差异有统计学意义(P<0.01)。CD4/CD8比值降低占48%,比值升高占24.4%,比值正常占27.6%。根据IgG、IgA、IgM的值进行分类,低下组占48.9%,升高组占20.4%,紊乱组占9.7%,正常组占21%。各免疫指标在治疗前后的比较差异无统计学意义,各免疫分组的临床资料比较差异也无统计学意义。结论MG患者的免疫状态比较复杂,以低下或抑制为主,还有相当比例在正常范围。IgG、IgA、IgM、CD3、CD4、CD8不能作为MG病情、疗效的惟一评价指标,但对指导治疗具有一定的参考价值。Objective To evaluate the clinical value of the indices, including IgG, IgA, IgM, CD3, CD4 and CD8. Methods Detect CD3, CD4, CD8 by flow cytometry and detect IgG, IgA, IgM by turbidimetric method. We analyzed clinical features according to different classification of immune index, and changes of the level of these immune indices before and after treatment. Result The level of IgG, IgA in patients with generalized MG Was higher than that of ocular MG （ P 〈 0. 05 ）. The ratio of CD4 to CD8 was classified into 3 groups： low （118 cases）, high （60 cases）, normal （68 cases）. Likewise, the level of IgG, IgA, IgM was classified into 4 groups： low （156 cases）, high （65 cases） , disorder （31 cases） , normal （67 cases）. There was no statistically significance on changes of level of these immune indices before and after treatment. There was no statistically significance on clinical materials among different groups. In the low group of humoral immunity, the remission ratio of the patients with the treatment of gamma globulin was higher than that of patients without gamma globulin （ 95.2%, 28. 8%, respectively. P 〈 0. 01 ） . Conclusion The immune indices of IgG, IgA, IgM, CD3, CD4, CD8 seemed to be irrelevant to severity of disease and prognosis. To some extent, these immune indices can be reference in the aspect of treatment.

关 键 词：重症肌无力 细胞免疫 体液免疫 

分 类 号：R746.1[医药卫生—神经病学与精神病学]