葡萄球菌蛋白A免疫吸附治疗全身型重症肌无力的临床研究

The clinical study of staphylococcal protein A immunoadsorption in the treatment of generalized myasthenia gravis

目的研究葡萄球菌蛋白A免疫吸附治疗全身型重症肌无力(myasthenia gravis,MG)的疗效和安全性。方法采用蛋白A免疫吸附治疗19例成人全身型MG并进行临床疗效和安全性的判定。结果所有入选病人均完成2次免疫吸附治疗;第2次治疗后的IgG、IgA、IgM浓度明显下降(P<0.0001);Osserman分级、改良美国MG基金会(MGFA)评分、MG日常生活量表(ADL)和徒手肌力量表(MMT)均明显改善(P<0.0001)。MG特异性乙酰胆碱受体(AChR)抗体阳性的患者2次治疗后抗体滴度明显下降;治疗后外周血调节性T细胞百分比明显上升。部分病人有轻度不良反应,但总体耐受性良好,各项安全性临床评定指标在治疗前后的变化均无统计学意义。结论葡萄球菌蛋白A免疫吸附可以迅速改善全身型MG病人的病情。

Objective To study the efficacy and safety of staphylococcal protein A immunoadsorption in the treatment of generalized myasthenia gravis, Methods Nineteen cases of definitely diagnosed generalized MG were treated with protein A immunoadsorption. Clinical and safety assessments were evaluated at baseline and after the first and second immunoadsorption. Results At the end of treatment, Osserman grade, MGFA, ADL and MMT were improved significantly （ P 〈 0. 0001 ）. Accordingly, serum IgG, IgA and IgM concentrations were decreased significantly（ P 〈 0, 0001 ）, Individuals with positive AChR antibody were found to have a lower titer after treatment. The percentage of peripheral regulatory T cells was increased after treatment, Some patients had mild side effect, but the general tolerance was good, All the safety param- eters showed no significant difference between baseline and post-treatment. Conclusions With possible mild side effect, staphylococcal protein A immunoadsorption could improve the symptoms of generalized myasthenia gravis quickly.