重症肌无力患者血清Ryanodine受体抗体与临床的相关性研究  

Clinical value of serum level of ryanodine receptor antibodies in diagnosis of myasthenia gravis

作　　者：阎志慧[1] 徐东[2] 董礼全[2] 高聆[3] 冯亚波[2] 王凤焰[2] 

机构地区：[1]山东省烟台市烟台山医院神经内科,264001 [2]山东大学山东省立医院神经内科,250021 [3]山东大学山东省立医院中心试验室,250021

出　　处：《中华神经医学杂志》2008年第12期1242-1244,共3页Chinese Journal of Neuromedicine

基　　金：山东省自然科学基金（200213YC）

摘　　要：目的探讨血清Ryanodine受体抗体（RyR-Ab）与重症肌无力（MG）的关系。方法应用ELISA和Western blot法分别检测81例MG患者、45例非MG神经系统其他疾病（NMG）患者和50例健康对照者（HC）血清中RyR-Ab水平。结果ELISA法显示：MG组RyR—Ab阳性率为23．4％，明显高于HC组和NMG组（均为阴性），差异有统计学意义（P〈0．05）；MG伴胸腺瘤（MGT）组阳性率最高（77．2％），MG伴胸腺萎缩（MGA）者次之（14．2％），MG伴胸腺增生（MGH）者为6．6％；而且RyR-Ab水平与肌无力的严重程度成正相关（r=0．547，P〈0．05）；RyR-Ab诊断MGT的敏感性（77．2％）低于胸腺CT（88．2％），但特异性（91％）高于后者（72．2％），差异有统计学意义（P〈0．05）。Western blot法显示：MGT组RyR-Ab阳性条带检出率最高（81．8％），明显高于非胸腺瘤MG（NTMG）组（4．5％）和NMG组（0），差异有统计学意义（P〈0．05）。结论RyR-Ab阳性多见于MGT，检测RyR-Ab可以弥补影像学的不足，有助于诊断MGT和评估病情。Objective To investigate the clinical value of detecting the serum level of ryanodine receptor antibodies （RyR-Ab） in the diagnosis and evaluation of myasthenia gravis （MG）. Methods Enzyme-linked immunosorbent assay （ELISA） and Western blotting were used to detect the serum level of RyR-Ab in 81 patients with MG, 45 non-MG patients with other neurological disorders and 50 healthy control subjects. Results The results of ELISA showed a serum RyR-Ab positivity rate of 23.4% in the in MG patients, significantly higher than the rates in non-MG patients and the healthy subjects （P〈0.05）. The serum RyR-Ab positivity rate was 77.2% in MG patients with thymoma （MGT）, 14.2% in those with thymic atrophy （MGA）, and 6.6% in those with thymic hyperplasia （MGH）. A positive correlation was found between the titer of serum RyR-Ab and the severity of muscle weakness （r=0.547, P〈0.05）. Compared with CT scanning, serum RyR-Ab level had low sensitivity （77.2%） but high specificity （91%, P〈0.05） for diagnosis of MGT. According to the results of Western blotting, the serum RyR-Ab positivity rate was 81.8% in MGT patients, significantly higher than that in thymoma-free MG patients and NMG patients （P〈0.05）. Conclusion RyR-Ab positivity is mainly found in MGT patients, and detection of serum RyR-Ab may help evaluate the severity of MG and assist in CT-based diagnosis of MGT.

关 键 词：重症肌无力 Ryanodine受体抗体 胸腺瘤 

分 类 号：R746.1[医药卫生—神经病学与精神病学]