摘要
目的探讨外周血单个核细胞(PBMC)糖皮质激素受体(GR)水平对预测糖皮质激素(GC)治疗(但未经其他免疫治疗)新发病重症肌无力(新发病MG)患者疗效的价值。方法收集100例新发病MG患者,用3H-地塞米松放射配体法测定PBMC中的GR数量,用ELISA法检测血清乙酰胆碱受体抗体(AChR-Ab)水平。肌无力严重程度和临床疗效判定采用临床绝对和相对记分法。结果(1)100例新发病MG患者,免疫治疗前PBMC GR数量[(3633±1711.2)位点/细胞]明显低于健康对照组[(5563±1232.6)位点/细胞],其血清AChR-Ab水平[(3.79±0.74)nmol/L]明显高于健康对照组(<2.996 nmol/L)(均P<0.01)。(2)20例新发病MG患者仅经GC治疗,治疗至少1个月后其PBMC GR水平和血清AChR-Ab水平均下调,分别为(1928.97±1025.47)位点/细胞和(3.05±0.78)nmol/L。(3)治疗前GR数量与临床相对评分呈正相关(r=0.41,P<0.05),GR数量下调与AChR-Ab下调呈正相关(r=0.478,P<0.05)。结论(1)新发病MG患者PBMC GR数量低于正常。(2)可用MG患者治疗前PBMC GR数量预测GC疗效,且治疗前PBMC GR数量高者疗效好。
Objective Myasthenia gravis （MG） is an autoimmune disease. The exact pathogenesis is still unclear. The endocrinological and immunological disturbances have been found in MG patients. Glucocorticoid （GC） is one of the potent immunosuppressive agents, an essential hormone for human, and clinically used in the treatment for MG. It is well known that action of GC is mediated through high affinity binding of GC to the glucocorticoid receptor （GR）. This study explores the relationship among GR, humoral immunity in new onset MG patients, and the possible mechanism of GC treatment in MG patients. Methods 3 H dexamethansone radioligand binding assay and Scatchard analysis were used to measure the number of GR in PBMC of 100 MG patients, who have never treated by immuno.suppressive agents（new onset MG patients） and 35 healthy controls. The serum levels AChR-Ab were determined by ELISA. In 20 new onset MG patients only treated with only GC, the efficacy of GC treatment for MG is assessed by relative clinical score. Results Before immunotherapy, the GR numbers in PBMC[（3633± 1711.2）sites/cell] were significantly lower in new onset MG patients than those in healthy controls [ （5563.3 ±1232.6） sites/cell. In 20 new onset MG patients only treated by GC, GR numbers of PBMC determined before GC treatment were significantly positively correlated with GC therapeutic efficacy（n = 20, r= 0.41, P〈0.05）. After initiation of GC treatment, there were significant positive correlation between the decrease of serum level of AChR-Ab and GR numbers in PBMC（r=0. 478, P〈0.05）. Conclusions （1）In new onset MG patients, the GR number in PBMC and the serum level of AChR-Ab is statistically significantly lower and higher than those in healthy controls respectively. It suggests that there are disturbances of humeral immunity in new onset MG patients. （2）The therapeutic efficacy of GC is significantly better in MG patient with higher GR number in PBMC than that with lower one. The GR number in PBMC of new
出处
《中国神经免疫学和神经病学杂志》
CAS
2008年第2期120-123,共4页
Chinese Journal of Neuroimmunology and Neurology
