重症肌无力患者血清四种抗体的检测及意义  

Detection of four serum antibodies in myasthenia gravis patients and its clinical values

作　　者：王巍炜[1] 郝洪军[2] 高枫[2] 

机构地区：[1]北京积水潭医院干部科,100035 [2]北京大学第一医院神经内科,100034

出　　处：《中国神经免疫学和神经病学杂志》2010年第5期355-357,360,共4页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨乙酰胆碱受体(AChR)抗体、乙酰胆碱酯酶(ACHE)抗体、Titin抗体、Ryanodine受体(RyR)抗体在重症肌无力(myasthenia gravis,MG)诊断中的临床意义。方法采用ELISA法检测89例MG患者、66例其他神经系统疾病患者和66名健康对照者上述血清4种抗体水平。结果 MG患者AChR抗体、AChE抗体、Titin抗体和RyR抗体的阳性率分别为53.9%、20.2%、64.0%和55.0%,明显高于对照组(P<0.05)。4种抗体联合检测,其敏感度和特异度分别为94.4%和84.0%。AChE抗体多见于AChR抗体阴性且对新斯的明试验反应差的MG患者。Titin抗体在MG合并胸腺瘤(MGT)患者中的阳性率高于未合并胸腺瘤的MG(nMGT)患者(P<0.05),其对MGT诊断的敏感度和特异度分别为82.2%和52.5%。晚发型MG患者血清Titin抗体和RyR抗体阳性率明显高于早发型MG(P<0.05)。将MG患者根据Osserman评分进行分型,Titin抗体阳性率与病情严重程度有关(P<0.05)。结论 AChR抗体、AChE抗体、Titin抗体和RyR抗体联合检测对诊断MG具有较高的敏感度和特异度。Titin抗体结合胸腺CT可能有助于提高MGT诊断的敏感度和特异度,Titin抗体多见于病情较重的患者。Objective To study the diagnostic values of the antibodies against aeetylcboline receptor （AChR）, acetyleholinesterase （ACHE）, titin and ryanodine receptor （RyR） in the serum of patients with myasthenia gravis （MG）. Methods The serum levels of these four antibodies were detected by ELISA in 89 cases with MG, 66 cases with other neurological diseases （OND） and 66 healthy controls （NC）. Results AChR, ACHE, titin and RyR antibodies were positive in 53.9%, 20.2%, 64.0% and 55.0% MG patients, respectively, which were higher than those in control groups （P〈0.05）. The combination of the four antibody assays provided 94.4% sensitivity and 84.0% specificity for the diagnosis of MG. AChE antibody was more common in AChR antibody negative patients, who were insensitive to neostigmine test. The MG patients with thymoma （MGT） had higher positive rate of titin antibody than those without thymoma （nMGT） （P〈0. 05）. Titin antibody provided 82.2% sensitivity and 52.5% specificity for the diagnosis of MGT. The levels of titin and RyR antibody were higher in late-onset MG than those in early-onset MG （P〈0. 05）. The severity of MG was graded by a modified Osserman scale and the proportion of titin antibody positive patients was increasing with the severity （P〈0.05）. Conclusions The combined assay of AChR, ACHE, titin and RyR antibodies can offer a better diagnostic method for MG than each antibody test alone. Titin antibody combined with computed tomography can provide higher sensitivity and specificity for MGT. Titin antibody occurred more frequently in severe MG.

关 键 词：重症肌无力 胸腺瘤 乙酰胆碱酯酶抗体 TITIN抗体 RyR抗体 

分 类 号：R746.1[医药卫生—神经病学与精神病学]