重症肌无力患者淋巴细胞糖皮质激素受体与激素疗效依赖性的关系

The dependable relationship between glucocorticoid receptor on lymphocytes and the effect of glucocorticoid in patients with myasthenia gravis.

目的 探讨重症肌无力患者外周血淋巴细胞糖皮质激素受体（ Ｇ Ｒ） 水平与糖皮质激素治疗敏感性的依赖关系。方法 采用放射配基受体结合分析法检测淋巴细胞糖皮质激素受体含量，同时应用相对临床记分法观察激素治疗反应，相对临床记分＞ ５０ ％ 为有效。结果 重症肌无力患者的淋巴细胞糖皮质激素受体较正常人显著增高，经激素治疗后下降至正常或正常以下，且激素治疗的近期疗效与 Ｇ Ｒ含量呈正相关， Ｇ Ｒ含量高者治疗敏感的百分率高，近期疗效好，反之则差。结论 Ｇ Ｒ 含量的变化与淋巴细胞亚群异常分布有关。 Ｇ Ｒ 含量的不同可能是临床上激素疗效不尽相同的原因之一，所以，保持一定水平的 Ｇ Ｒ 含量对治疗有益。

s Objective To detect the dependable relationship between glucocorticoid receptor (GR) on lymphocytes and effect of glucocorticoid (GC) therapy in patients with myasthenia gravis (MG). Methods GR was measured with radioligand binding assay and the response of GC therapy was observed with Relative Clinical Score(RCS).It was effective when the RCS was more than 50%.Results The GR mean values level was significantly higher than in the controls. After GC therapy, the GR mean values decreased to normal or lower than normal levels. The higher the GR mean values were, the higher the sensitivity of GC therapy and the better the shortime effect were. On the contrary, the lower the GR mean values were, the lower the sensitivity was. Conclusions The change of the GR mean values and the abnormal distribution of T lymphcyte subsets were related . The different GR levels may be one reason for the different effects of GC therapy. So, to keep sufficient GR levels is beneficial to patients with MG.