重症肌无力患者血清titin抗体和乙酰胆碱受体抗体与疾病临床特征的关系  

The clinical significance of serum anti-titin antibodies and anti-acetylcholine receptor antibodies in patients with myasthenia gravis

作　　者：朱殊 万琛宜[2] 赵斐[2] 朱敏[2] 洪道俊[2] 万慧[2] 

机构地区：[1]江西省景德镇市第一人民医院神经内科,333000 [2]南昌大学第一附属医院神经内科,330006

出　　处：《中国神经免疫学和神经病学杂志》2012年第6期436-438,443,共4页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨重症肌无力(MG)患者血清titin抗体及乙酰胆碱受体(AChR)抗体与疾病临床特征的关系。方法采用酶联免疫吸附试验对90例MG患者和30例对照组成员进行titin抗体和AChR抗体的检测并进行比较。结果 MG患者AChR抗体、Titin抗体阳性率(76.7%,54.5%)明显高于对照组(10%,6.7%)(χ2=41.667,P=0.000;χ2=21.017,P=0.000)。titin抗体与AChR抗体检测MG的灵敏度分别为54.5%和76.7%,两种抗体并联试验灵敏度为89.4%。titin抗体在伴胸腺病变及晚发型MG患者中有较高阳性率,分别为80.0%和72.5%,明显高于非胸腺瘤组(47.1%,χ2=6.771,P=0.009)和早发型MG患者(40%,χ2=9.46,P=0.002)。全身型MG患者titin抗体与AChR抗体阳性率(69.2%,90.4%)显著高于眼肌型MG(34.2%,χ2=10.856,P=0.001;57.9%,χ2=12.956,P≤0.000)。甲亢组与非甲亢组MG患者titin抗体(33.3%,56.8%)与AChR抗体阳性率(55.6%,79%)差异性均无统计学意义(χ2=1.797,P=0.19;χ2=2.491,P=0.063)。结论 MG患者病情越重,titin抗体与AChR抗体阳性率越高。Titin抗体及AChR抗体能作为诊断MG的指标,联合检测能提高MG诊断的灵敏。然而MG患者血清titin抗体与AChR抗体并无一致性关系。Objective To investigate the clinical significance of serum anti-titin antibodies （titin-Ab） and anti-acetylcholine receptor antibodies （AChRAb） in patients with myasthenia gravis （MG）. Methods To detect titin-Ab and AChRAb with enzyme linked immunosorbent assay （ELISA） in the sera from 90 cases of MG group and 30 cases of control group. Results The positive rates of titin-Ab and AChRAb （76.7 %, 54.5 %） in MGgroup were significantly higher than those of control group （X2=41.667, P=0.000; X2=21.017, P= 0. 000）. The sensitivities of titin-Ab and AChRAb in MG patients were 54.5%and 76.7% respectively. The sensitivity of parallel test was 89.4%. The positive rates of titin-Ab were significantly higher in MG with thymoma （80.0%） and late-onset MG （72.5%） subgroups than in the MG without thymoma （47. 1%, X2 = 6. 771, P=0. 009） and early-onset MG subgroups （40.0%, X2=9.46, P=0. 002）. The positive rates of both antibodies in generalized MG patients （69.2%, 90.4%） were higher than those in ocular MG patients （34.2%, X2=10.856, P=0.001; 57.9%, X2=12.956, P≤0.000）. There was no significant difference in the positive rate of titin-Ab （33.3%, 56.8%） and AChRAb （55.6%, 790/00） between MG patients with and without hyperthyroidism （X2 =1. 797, P=0. 19; X2 =2. 491, P=0. 063）. Conclusions Titin-Ab and AChRAb can be used as indicators of the diagnosis of MG. Testing for a combination of titin-Ab and AChRAb gives higher sensitivity for the detection of MG than testing each antibody alone. The more severe the MG was, the higher positive rates of titin-Ab and AChRAb were. Titin-Ab and AChRAb titers were not correlated in MG patients.

关 键 词：重症肌无力 TITIN抗体 AChR抗体 神经免疫 

分 类 号：R746.1[医药卫生—神经病学与精神病学]