重症肌无力合并胸腺病变患者血清AchR抗体、Titin抗体和RyR抗体的检测及其临床意义  

Determination and clinical significance of serum acetylcholine receptor antibodies, titin antibodies, and ryanodine receptor antibodies in patients with thymic lesion and myasthenia gravis

作　　者：王泳心[1] 崔有斌[1] 周达[1] 单雪[1] 

机构地区：[1]吉林大学白求恩第一医院,吉林省长春市130021

出　　处：《实用医学杂志》2012年第2期218-221,共4页The Journal of Practical Medicine

基　　金：科技厅基金资助(编号:20090720)

摘　　要：目的:通过检测不同分组患者血清中乙酰胆碱受体抗体(AchR-Ab)、连接素抗体(Titin antibodies,Titin-Ab)和兰尼碱受体抗体(Ryanodine receptor,RyR-Ab)的表达,探讨以上三种抗体在重症肌无力(myasthenia ggravis,MG)诊断和治疗中的临床意义。方法:应用ELISA法对34例MG合并胸腺病变且接受胸腺完整切除的患者,28例其他神经系统疾病的患者和30例正常健康者的血清内进行AchR抗体、Titin抗体和RyR抗体的检测,并于MG合并胸腺病变患者行胸腺切除术后1周及术后3个月时重复检测。结果:MG合并胸腺病变组患者血清内的AchR抗体、Titin抗体要明显高于其他两对照组(P<0.01),RyR抗体水平亦高于其他两组(P<0.05);伴胸腺瘤的重症肌无力(mg with thymoma,MGT)组患者的Titin抗体、RyR抗体明显高于伴胸腺增生的重症肌无力(mg with thymic hyperplasia,MGH)和伴胸腺囊肿的重症肌无力(mg with thymic cyst,MGC)组患者(P<0.01),AchR抗体对MGT组患者亦有较高的阳性率(P<0.05);胸腺切除治疗后仅MGT组患者的AchR-Ab在第一周即发生明显下降(P<0.01),RyR-Ab在术后3个月时有下降(P<0.05),而其他组MG患者的三种抗体均未发现在胸腺切除前后有何变化(P>0.05)。结论:AchR-Ab、Titin-Ab和RyR-Ab与MG的发病机制有关;三种抗体均有助于对MG患者的诊断,其中Titin-Ab和RyR-Ab可用于胸腺瘤的鉴别诊断,并可作为诊断MGT的主要客观指标;对于MGT经胸腺切除术后患者可通过检测AchR抗体观察早期病情改变,检测RyR-Ab亦可作为其中远期病情改变的客观指标,但这两项指标与患者预后恢复情况的相关性还有待于进一步研究。Objective To investigate the expressions and significances of serum acetylcholine receptor antibodies （ AchR- Ab）, Titin antibodies （Titin-Ab）, and ryanodine receptor antibodies （RyR-Ab） in patients with thymic lesion and myasthenia gravis （MG）. Methods The expressions of serum AehR-Ab, Titin-Ab, and RyR- Ab in 34 patients with thymic lesion and MG who received thymectomy （MG group）, 28 patients with nervous system disease （positive control group）, and 30 normal controls （control group） were detected by ELISA, which was repeated in patients with MG 1 week and 3 months after surgery. Results The expressions of AchR-Ab, Titin-Ab, and RyR-Ab in MG group were significantly higher than those in the other 2 control groups （P 〈 0.01 or P 〈 0.05 ）. The expressions of AchR-Ab, Titin-Ab, and RyR-Ab in MG patients with thymoma were significantly higher than those in MG patients with hyperplasia and MG patients with thymic cyst （P 〈 0.01 or P 〈 0.05）. The expression of AchR-Ab in MG patients with thymoma was decreased 1 week after thymectomy （P 〈 0.01）, and RyR-Ab was decreased 3 months after thymectomy （P 〈 0.05）. Conclusion AchR-Ab, Titin-Ab, and RyR-Ab are associated with the pathogenesis of MG. The expression of AchR-Ab is associated with the early changes of disease, and RyR- Ab is associated with the later changes of disease.

关 键 词：重症肌无力 ACHR-AB Titin—Ab RyR—Ab 胸腺切除术 

分 类 号：R746.1[医药卫生—神经病学与精神病学]