不同抗体亚型重症肌无力患者的临床及电生理特征分析  

Analysis of clinical and electrophysiological characteristics of patients with myasthenia gravis of different antibody subtypes

作　　者：易可慧 邵志海 董继宏 费国强[1] YI Kehui;SHAO Zhihai;DONG Jihong;FEI Guoqiang(Department of Neurology,Zhongshan Hospital(Xiamen Branch),Fudan University,Fujian,Xiamen 361006,China;Department of Neurology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院(厦门)神经内科,福建厦门361006 [2]复旦大学附属中山医院神经内科,上海200032

出　　处：《中国医药科学》2023年第24期185-189,共5页China Medicine And Pharmacy

基　　金：福建省卫健委科技计划项目(2020CXB049)。

摘　　要：目的分析不同抗体亚型重症肌无力(MG)患者的临床及电生理特征。方法纳入2019年8月至2023年8月复旦大学附属中山医院(厦门)神经内科收治的确诊为MG的患者62例,回顾性收集患者的临床资料,并根据血清抗体类型分为抗乙酰胆碱受体抗体阳性(AchR-MG)组、肌肉特异性酪氨酸激酶抗体阳性(MuSK-MG)组、血清双抗体阴性(DSN-MG)组,比较分析三组患者人口学资料、临床分型和新斯的明试验结果、首发肌群分布、伴随自身免疫性疾病、伴发胸腺病变、重复电刺激结果等。结果研究纳入的62例MG患者中,AchR-MG组患者36例(58.06%),MuSK-MG组患者5例(8.06%),DSNMG组患者21例(33.87%),DSN-MG组全身型患者比例低于其余两组,差异有统计学意义(P<0.05)。MuSK-MG组首发症状累及球部肌群比例高于AchR-MG组、DSN-MG组,差异有统计学意义(P<0.05)。MuSK-MG组首发肌群累及眼部肌群比例低于AchR-MG组、DSN-MG组,差异有统计学意义(P<0.05)。AchR-MG组新斯的明试验阳性率高于MuSK-MG组和DSN-MG组,差异有统计学意义(P<0.05)。MuSK-MG组RNS总阳性率高于AchR-MG组、DSN-MG组,差异有统计学意义(P<0.05),其中面神经RNS阳性率显著高于其余两组(P<0.05),而三组腋神经、副神经、正中神经RNS阳性率差异无统计学意义(P>0.05)。三组胸腺瘤发生率差异有统计学意义(P<0.05),而三组发病年龄、性别、风湿免疫自身抗体异常发生率、甲状腺功能异常发生率、胸腺增生/退化不全发生率差异无统计学意义(P>0.05)。结论不同致病抗体亚型MG患者在临床分型、首发肌群、新斯的明试验阳性率、胸腺瘤发生率、RNS阳性率等方面存在显著差异。Objective To analyze the clinical and electrophysiological characteristics of patients with myasthenia gravis(MG)of different antibody subtypes.Methods A total of 62 patients diagnosed with MG admitted to the Department of Neurology of Zhongshan Hospital,Fudan University(Xiamen Branch)from August 2019 to August 2023 were included.Clinical data of the patients were retrospectively collected,and the patients were divided into three groups based on the type of serum antibody:the anti-acetylcholine receptor antibody positive(AchR-MG)group,the muscle-specific receptor tyrosine kinase antibody positive(MuSK-MG)group,and the double seronegative(DSN-MG)group.The demographic data,clinical classification and distributioh of first-episode muscle groups,accompanying autoimmune diseases,accompanying thymic lesions,repetitive electrical stimulation results of the three groups of patients were compared and analyzed.Results Among the 62 MG patients included in the study,there were 36 patients(58.06%)in the AchR-MG group,5 patients(8.06%)in the MuSK-MG group,and 21 patients(33.87%)in the DSN-MG group.The proportion of generalized MG patients in the DSN-MG group was lower than that in the other two groups,with statistically significant difference(P<0.05).The proportion of the first-episode symptom involving the bulbar muscle group in the MuSK-MG group was higher than that in the AchR-MG group and DSN-MG group,with statistically significant difference(P<0.05).The proportion of the first-episode muscle group involving the eye muscles in the MuSK-MG group was lower than that in the AchR-MG group and DSN-MG group,with statistically significant difference(P<0.05).The positive rate of neostigmine test in the AchR-MG group was higher than that in the MuSK-MG group and DSN-MG group(P<0.05).The total positive rate of RNS in the MuSK-MG group w as higher than that in the AchR-MG group and DSN-MG group(P<0.05),and the positive rate of RNS in the facial nerve was significantly higher than that in the other two groups(P<0.05).However,there was

关 键 词：重症肌无力 乙酰胆碱受体抗体 肌肉特异性激酶受体抗体 重复电刺激 血清抗体亚型 

分 类 号：R746.1[医药卫生—神经病学与精神病学]