丙种球蛋白与甲泼尼龙治疗重症肌无力的疗效及对淋巴细胞亚群与Treg/Th17的影响  

Efficacy of gamma globulin and methylprednisolone in treatment ofmyasthenia gravis and their effects on lymphocyte subsets and Treg/Th17

作　　者：陈晓静 程曼 张雪芳[1] 秦慧兵[1] 刘红钊[1] CHEN Xiao-jing;CHENG Man;ZHANG Xue-fang;QIN Hui-bing;LIU Hong-zhao(Department of Neurology,Nanyang Central Hospital,Nanyang,Henan 473000,China)

机构地区：[1]南阳市中心医院神经内科,河南南阳473000

出　　处：《医药论坛杂志》2024年第4期413-418,共6页Journal of Medical Forum

摘　　要：目的探究丙种球蛋白与甲泼尼龙治疗重症肌无力的疗效及对淋巴细胞亚群与对调节性T细胞(Treg)/辅助性T细胞17(Th17)的影响。方法前瞻性选取2020年7月至2022年10月南阳市中心医院收治的重症肌无力患者80例为研究对象,按随机数排秩法将患者分为研究组40例与对照组40例,对照组予以甲泼尼龙治疗,研究组在对照组基础上予以丙种球蛋白治疗,两组均治疗6个月,比较两组疗效、淋巴细胞亚群指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、CD4^(+)/CD25^(+))、Treg(Treg、CD4^(+)CD25^(+)FOX3^(+)百分比)、Th17细胞与不良反应的差异。结果等级资料秩和检验结果显示,两组治疗3个月后、治疗6个月后的疗效比较差异存在统计学意义(Z=8.344、4.944,P<0.05),且研究组治疗3个月后、治疗6个月后的总有效率均高于对照组(P<0.05)。两组患者治疗6个月后的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)与治疗前相比均升高(P<0.05),而CD8^(+)、CD4^(+)/CD25^(+)均降低(P<0.05),且研究组治疗6个月后淋巴细胞亚群相关指标升高降低幅度均优于对照组(P<0.05)。重复测量方差分析结果显示,两组治疗3个月后、治疗6个月后Th17细胞频数、Treg与治疗前相比均显著降低,而CD4^(+)CD25^(+)FOX3^(+)百分比均降低(P<0.05),且研究组治疗3个月后、治疗6个月后上述指标升高降低幅度均优于对照组(P<0.05)。两组患者不良反应发生情况与总不良反应发生率比较差异无统计学意义(P>0.05)。结论丙种球蛋白联合甲泼尼龙治疗重症肌无力具有较好疗效,可通过调节Treg/Th17细胞值,改善机体免疫功能进而发挥治疗效果。Objective To explore the efficacy of gamma globulin and methylprednisolone in the treatment of myasthenia gravis,as well as their effects on lymphocyte subsets and regulatory T cells(Treg)/helper T cell 17(Th17).Methods Aprospective study was conducted on 80 patients with myasthenia gravis admitted to our hospital from July 2020 to October 2022.The patients were randomly divided into a study group of 40 cases and a control group of 40 cases.The control group received methylprednisolone treatment,while the study group received gamma globulin treatment on the basis of the control group.Both groups were treated for 6 months,and the efficacy and lymphocyte subgroup indicators(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),CD4^(+)/CD25^(+))were compared between the two groups Differences in Treg(percentage of Treg,CD4^(+)CD25^(+)FOX3^(+)),Th17 cells,and adverse reactions.Results The rank sum test results of the hierarchical data showed that there was a statistically significant difference in the efficacy between the two groups after 3 months of treatment and 6 months of treatment(Z=8.344,4.944,P<0.05),and the total efficacy rate of the study group after 3 months of treatment and 6 months of treatment was higher than that of the control group(P<0.05).After 6 months of treat ment,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in both groups of patients increased compared to before treatment(P<0.05),while CD8^(+)and CD4^(+)/CD25^(+)decreased(P<0.05).Moreover,the increase and decrease in lymphocyte subpopulation related indicators in the study group after 6 months of treatment were better than those in the control group(P<0.05).The results of repeated measurement analysis of variance showed that after 3 months and 6 months of treat-ment,the frequency of Th17 cells and Treg in both groups significantly decreased compared to before treatment,while the percentage of CD4^(+)CD25^(+)FOX3^(+)decreased(P<0.05).Moreover,the increase and decrease in the above indicators in the study group after 3 months and 6 months of treatment were bette

关 键 词：重症肌无力 丙种球蛋白 甲泼尼龙 疗效 淋巴细胞亚群 调节性T细胞 辅助性T细胞17 

分 类 号：R746.1[医药卫生—神经病学与精神病学]