血清AChRab、PsMab和CAEab检测在胸腺异常患者中的诊断意义  

Significance of serum AChRab,PsMab and CAEab for the diagnosis of patients with thymic abnormalities and thymoma with myasthenia gravis

作　　者：武茜[1] 顾萍[1] 姚娟[1] 邓晓萱[1] 程虹[1] 万琪[1] 张克忠[1] 陈亮[2] 徐心峰 WU Qian;GU Ping;YAO Juan;DENG Xiaoxuan;CHENG Hong;WAN Qi;ZHANG Kezhong;CHEN Liang;XU Xinfeng(Derpartment of Neurology,the First Affiliated Hospital of Nanjing Medical University,Nanjing Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院神经科,210029 [2]江苏省人民医院胸外科,210029

出　　处：《中国神经免疫学和神经病学杂志》2017年第5期344-348,共5页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨血清抗乙酰胆碱受体抗体(AChRab)、抗突触前膜抗体(PsMab)和柠檬酸提取物相关抗体(CAEab)在胸腺异常患者中的诊断价值。方法回顾性收集2009—2016年作者医院收治的经病理检查证实存在胸腺异常的患者152例,同时收集健康体检者45名(NC组)和其他神经系统疾病患者35例(OND组)作为对照组。采用ELISA方法检测各组AChRab、PsMab和CAEab水平,比较各组不同抗体阳性率的差异,并进一步比较不同胸腺异常者间各抗体阳性率差异。结果 (1)胸腺瘤、胸腺增生组血清AChRab、PsMab和CAEab阳性率明显高于NC及OND组(均P<0.01),且胸腺瘤组上述3种抗体阳性率高于胸腺囊肿组(P<0.01或P<0.05)。胸腺囊肿组与NC及OND组各抗体阳性率比较无统计学差异(P>0.05)。CAEab对胸腺瘤患者诊断灵敏度为60.6%,特异度为88.8%。(2)重症肌无力合并胸腺瘤(MGT)组PsMab阳性率高于非合并MG胸腺瘤(NMGT)组(P<0.05),而其AChRab及CAEab阳性率与NMGT组比较无统计学差异(P>0.05)。(3)MGT组中,MGT-全身型组血清AChRab阳性率较MGT-眼肌型组增高(P<0.05)。(4)胸腺瘤不同病理分型患者间各抗体阳性率比较无统计学差异(均P>0.05)。结论 (1)CAEab检测结合CT检查可作为临床可疑胸腺瘤、胸腺增生患者术前辅助诊断指标之一。(2)AChRab阳性可能与MGT患者重症肌无力严重程度有关,PsMab阳性可能跟MGT患者致病有关。ObjectiveTo explore the diagnostic value of serum anti acetylcholine receptor antibody(AChRab),presynaptic membrane antibody(PsMab)and citrate extract related antibody(CAEab)in patients with thymus abnormalities MethodsWe collected152patients with thymus abnormalities from2009-2016,and collected45healthy subjects(NC group)and35patients with other diseases of the nervous system(OND)as another control group The serum levels of AChRab,PsMab and CAEab of each group were detected by the ELISA method,and the positive rates of different antibodies in each group and patients with different kinds of thymus abnormalities were compared Results(1)The positive rates of serum AChRab,PsMab and CAEab in the thymoma and thymic hyperplasia groups were significantly higher than those of the NC and OND group(all P<001),and the above three kinds of antibodies in the thymoma group were higher than those of the thymic cyst group(P<001or P<005)There was no statistical significant difference in the positive rates of the three antibodies between the thymus cyst group and the NC and OND groups(P>005)The diagnostic sensitivity of CAEab to the patients with thymoma was606%,and the specificity was888%(2)The positive rate of PsMab in the patients with myasthenia gravis combined with thymoma(MGT)group was higher than that in the non MG thymoma(NMGT)group(P<005),but the positive rates of AChRab and CAEab were not significantly different from those of the NMGT group(P>005)(3)In the MGT group,the serum AChRab positive rate of generalized MG patients was higher than that of the ocular MG group(P<005)(4)There was no statistical significant difference of the positive rate of antibodies in patients with different pathological subtypes of thymoma(all P>005)Conclusions(1)CAEab detection combined with CT can be used as one of the preoperative diagnostic indexes of patients with suspected thymoma and thymic hyperplasia(2)AChRab serum level may be related to the severity of myasthenia gravis in patients with MGT;PsMab may be associated with MGT

关 键 词：胸腺增生 胸腺瘤 纵隔囊肿 重症肌无力 乙酰胆碱受体抗体 抗突触前膜抗体 柠檬酸提取物相关抗体 

分 类 号：R746.1[医药卫生—神经病学与精神病学]