联合检测重症肌无力的三种血清抗体诊断  

Three kinds of serum antibodies detection in the diagnostic value of patients with myasthenia gravis

作　　者：梁芸[1] 万玲玲[1] 张华俐[1] 王之瑜[1] 杨红霞[1] 郑梅[1] 

机构地区：[1]石家庄市第一医院检验科,河北050051

出　　处：《脑与神经疾病杂志》2017年第5期303-306,共4页Journal of Brain and Nervous Diseases

基　　金：河北省医学科学研究重点课题指导计划(ZD20140068)

摘　　要：目的对重症肌无力(MG)患者的乙酰胆碱受体抗体(Ach R-Ab)、连接素抗体(Titin-Ab)和肌肉特异性酪氨酸激酶抗体(Mu SK-Ab)评价该3种血清抗体联合检测对MG的诊断价值。方法选择MG组患者112例、其他疾病对照组53例和健康对照组56例,采用放射免疫法测定Ach R-Ab,ELISA法分别测定Titin-Ab和Mu SK-Ab,并对结果进行分析。结果 MG患者Ach R-Ab、Titin-Ab和Mu SK-Ab的阳性率分别为68.8%、54.5%和5.4%,明显高于对照组(P<0.05)。三种抗体联合检测,其敏感性和特异性分别为91.1%和89%。其中,Mu SK-Ab仅见于Ach R-Ab阴性的MG患者,主要表现为延髓肌受累,病情较重且不伴有胸腺病变。Titin-Ab多见于MG合并胸腺瘤(MGT)患者,其MGT组的阳性率高于未合并胸腺瘤的MG(NTMG)患者(P<0.05)。将MG患者根据Osserman评分进行分型,Titin-Ab阳性率与病情严重程度有关(P<0.05)。结论 Ach R-Ab、Titin-Ab、Mu SK-Ab三种抗体是MG的诊断性标记抗体,联合检测可以避免因单项检测出现的漏诊和误诊,此外,Titin-Ab对MG合并胸腺瘤具有显著相关性,还可作为判断MG病情严重程度的指标。Objective To detect the acetylcholine receptor antibodies （ AchR-Ab ） , connecting element （ Titin-Ab ） and muscle specific tyrosine kinase antibody （ MuSK-Ab ） for the clinical diagnosis and treatment of myasthenia gravis （ MG ） . Method Select one hundred and twelve cases of patients with MG group and control group of fifty-three cases of other diseases and health control group fifty-six cases, AchR-Ab was evaluated by radioimmunity method, while Titin-Ab and MuSK-Ab were detected by ELISA respectively. The results were analyzed. Results AchR-Ab, Titin-Ab and MuSK-Ab positive rate were 68.8%, 54.5% and 5.4% in myastbenia gravis, significantly higher than control group （P〈 0.05 ） . Sensitivity and specificity of joint detection were 91.1% and 89% respectively. MG patients with the MuSK-Ab restricted to AchR-Ab negative main involved the medulla oblongata muscle, they were heavier and without thyrmus pathological changes. Titin-Ab of MG patients with thymoma （ MGT ） were higher than that of MG patients without thymoma （ P〈0.05 ） . According to the Osserman score ,Titin-Ab positive rate of MG were associated with disease severity （ P〈0.05 ） . Conclusion AchR-Ab, Titin-Ab and MuSK-Ab were a diagnostic markers of MG patients. The joint detection can avoid missed diagnosis and misdiagnosis .In addition, Titin-Ab of MG combined thymoma might be has significant correlation and as a judge index of illness severity.

关 键 词：乙酰胆碱受体抗体 连接素抗体 特异性酪氨酸激酶抗体 胸腺瘤 

分 类 号：R746.1[医药卫生—神经病学与精神病学]