重症肌无力抗体测定数值分布特征与相关分析  

Distribution characteristics and correlation analysis of antibody detection value in myasthenia gravis

作　　者：刘怡琳 郑艺明[1] 罗晶晶[1] 张巍[1] 高枫[1] 袁云[1] 郝洪军[1] Liu Yilin;Zheng Yiming;Luo Jingjing;Zhang Wei;Gao Feng;Yuan Yun;Hao Hongjun(Department of Neurology,Peking University First Hospital,Beijing100034,China)

机构地区：[1]北京大学第一医院神经内科,北京100034

出　　处：《中华医学杂志》2019年第41期3221-3226,共6页National Medical Journal of China

基　　金：国家十二五科技部重大专项子课题(2011ZX09307-001-07)。

摘　　要：目的探讨影响重症肌无力(MG)不同抗体测定数值分布特征与数值大小的相关因素。方法研究纳入了2015年5月至2017年11月就诊于北京大学第一医院神经内科的406例MG患者。所有患者均具有病理性肌疲劳现象,低频神经重复电刺激出现波幅递减,对溴比斯的明治疗有效。其中男200例,女206例,年龄2~85岁。美国重症肌无力协会(MGFA)临床分型的Ⅰ~Ⅴ型分别有200例、140例、46例、15例及5例。影像学或病理检查证实33例患者具有胸腺增生,63例患者具有胸腺瘤。依据年龄、性别、MGFA分型及胸腺病变情况对患者进行分组。利用分位数与分位数曲线分析不同分组经酶联免疫吸附测定(ELISA)方法检测所得的乙酰胆碱受体(AChR)抗体、乙酰胆碱酯酶(AChE)抗体、骨骼肌受体酪氨酸激酶(MuSK)抗体、肌联蛋白(Titin)抗体和兰尼碱受体(RyR)抗体的吸光度(A)值分布特征。利用分位数回归模型进行吸光度(A)值与年龄、性别、MGFA分型及胸腺病变的相关性分析。结果AChR抗体吸光度(A)值在不同MGFA分型之间分布差异最为明显。年龄与AChR抗体吸光度(A)值具有正相关(P<0.05),与AChE抗体、Titin抗体及RyR抗体吸光度(A)值具有负相关(P<0.05),与MuSK抗体吸光度(A)值没有回归相关性(P≥0.05)。MGFA分型与AChR抗体吸光度(A)值具有正相关(P<0.05),与其他抗体吸光度(A)值不具有回归相关性。性别及胸腺病变与上述抗体吸光度(A)值都不具有回归相关。结论MGFA分型对AChR抗体测定数值的分布特征影响最为显著。年龄和MGFA分型与AChR抗体测定数值具有正相关。Objective To determine the factors affecting distribution and magnitude of antibody detection value in myasthenia gravis(MG).Methods A total of 406 MG patients diagnosed at Department of Neurology,Peking University First Hospital from May 2015 to November 2017 were included.All of them exhibited muscle fatigue with decreased response in repetitive nerve stimulation test.There were 200 males and 206 females whose ages ranged from 2 to 85 years old.According to clinical classification of MG recommended by Myasthenia Gravis Foundation of America(MGFA),patients assigned to class I to class V included 200,140,46,15 and 5 cases,respectively.There were 33 cases of thymic hyperplasia and 63 cases of thymoma confirmed by radiological or pathological findings.Quantile plots and quantile regression model were used to determine the effects of age,gender and MGFA classification,thymus disease on acetylcholine receptors(AChR)antibody,acetylcholinesterase(AChE)antibody.Titin antibody,ryanodine receptor(RyR)antibody and muscle-specific tyrosine kinase(MuSK)antibody detection values detected by enzyme-linked immunosorbent assay(ELISA).Results MGFA classification had effects on distribution of AChR antibody level.There was a positive correlation between age and AChR antibody level(P<0.05).Negative correlation was found between age and AChE,Titin and RyR antibody level(P<0.05).No significant correlation was shown between any factors and MuSK antibody level(P^0.05).MGFA classification had a positive correlation with AChR antibody level(P<0.05)and no correlation with other antibody levels(P>0.05).Gender and thymus disease had no correlation with any tested antibody levels(P>0.05).Conclusion MGFA classification has significant effects on distribution of AChR antibody level.Age and MGFA classification have positive correlation with AChR antibody level.

关 键 词：重症肌无力 抗体 年龄因素 MGFA分型 分位数回归 

分 类 号：R74[医药卫生—神经病学与精神病学]