自身免疫性重症肌无力患者选择他汀类药物辅助间充质干细胞输注治疗的效果

Effect of statins combined with mesenchymal stem cell infusion in treatment ofautoimmune myasthenia gravis

目的研究骨髓间充质干细胞输注联合他汀类药物用于自身免疫性重症肌无力(MG)患者的临床效果。方法连续选择2013年2月—2014年5月来医院确诊的自身免疫性重症肌无力患者共20例,将其随机分为对照组和观察组各10例,对照组患者给予常规的激素和(或)免疫抑制剂治疗,观察组患者给予联合骨髓间充质干细胞和他汀类药物应用,对比2组患者的肌力Lennon评分、临床症状的综合功能进步评分包括进步程度、认识功能、运动功能、自理动作以及社会适应指标,及CD4^+T淋巴细胞表面CD28的表达和IL-4水平的差异性。结果随访约3个月后,2组患者的Lennon评分均降低,综合功能评分均升高,且观察组变化的更明显,差异有统计学意义(P<0.05)。进一步比较2组患者的综合功能评分,观察组患者的进步程度、认识功能、运动功能、自理动作以及社会适应评分均显著高于对照组,差异均有统计学意义(P<0.05)。治疗后2组患者的CD28分子和IL-4水平均降低,且观察组降低的更明显,差异有统计学意义(P<0.05)。结论骨髓间充质干细胞联合他汀类药物能够有效改善MG患者肌无力的临床效果,可能跟CD4^+T淋巴细胞表面CD28的表达和IL-4水平的降低有关。

Objective To research clinical effect of statins combined with mesenchymal stem cell infusion in treatment of autoimmune myasthenia gravis. Methods A total of 20 consecutivecasesof autoimmune myasthenia gravisbetween Febru- ary ,2013 and May,2014 were divided randomly into control group and experiment group with 10 cases in each group. The patients in the control group received conventional hormone and（or） immunosuppressive therapy, while the patients in the experiment group received statins combined with mesenchymal stem cell infusion. Lennon score of muscle strength, com- prehensive function score of clinical symptoms including progress degree, cognitive function, motor function, self-care ac- tion and social adaptation, and CD28 expression of CD4^＋ T lymphocyte cell and IL-4 level were compared between the two group. Results After about three months of follow-up, two groups of patients Lennon scores were lower, comprehensive function scores were increased, and the more obvious changes in the observation group, groups were significantly more when compared with those the control group（ P 〈 0.05 ）. And the progress degree, cognitive function, motor function, self- care action and social adaptation scores in the experiment group were all better as compared with the control group（P 〈 0.05 ）. CD28 expression and IL-4 levels after the treatment were lower in both groups, especially in the experiment group （P 〈0.05）. Conclusion The statins combined with mesenchymal stem cell infusion can greatly improve the clinical symptoms of patients with antoimmune myasthenia gravis by decreasing CD28 expression and IL-4 levels.