重症肌无力患者糖皮质激素受体含量与疗效的关系

A study of the relationship between the contents of glucocorticoid receptors in myasthenia gravis patients and the efficacy of steroid therapy

目的探讨重症肌无力患者外周血白细胞糖皮质激素受体含量与应用糖皮质激素治疗效果的关系。方法用放射免疫法测定４１例患者和２５名健康对照者血糖皮质激素水平，采用放射性配体结合法测定患者经糖皮质激素治疗前后外周血白细胞糖皮质激素受体含量。结果（１）患者白细胞糖皮质激素受体平均值为（６７６５±９７４）位点／细胞，明显高于正常对照组［（２７４０±７２５）位点／细胞］（Ｐ＜０．００１）。（２）患者血浆皮质醇浓度（４５８±１７０）ｎｍｏｌ／Ｌ，对照组为（４１３±１５６）ｎｍｏｌ／Ｌ，二者差异无显著意义。（３）治疗前糖皮质激素受体位点数高者［（７３３４±５９９）位点／细胞，２５例］治疗效果好，而治疗前位点数低者［（５７７９±６５４）位点／细胞，１６例］治疗效果差（Ｐ＜０．０５）。（４）重症肌无力患者经糖皮质激素治疗后，糖皮质激素受体位点数较治疗前下降。结论重症肌无力患者外周血白细胞糖皮质激素受体含量增多，增多的程度与近期疗效有关，受体含量高者治疗效果好。

Objective To investigate the relationship between the contents of glucocorticoid receptors (GCR) in myasthenia gravis and the curative effects of steroid therapy. Methods The concentrations of plasma glucocorticoid were measured with radioimmunoassay and the levels of peripheral leucocytes with a whole cell binding assay with 3H dexamethasons in myasthenia gravis before and after treatment. Results (1) GCR binding mean values were (6 765±974) sites/cell in the peripheral blood leukocytes of 41 myasthenia gravis patients who had not received glucocorticoid for at least two months. They were significantly higher than those of the healthy dorners [(2 740±725) sites/cell, P <0.001]. (2) The blood plasma mean level of the glucocorticoid in myasthenia gravis patients was (458±170) nmol/L. There was no statistically significant difference between the corresponding mean levels of the patients and the donors[(413±156) nmol/L]. (3) After having received glucocorticoid for two months, 25 patients improved with their GCR binding mean values reaching (7 334±599) sites/cell. The therapeutic effects were not better in 16 patients who had lower GCR binding mean values [(5 779± 654) sites/cell, P <0.05]. (4) The GCR binding mean values in the myasthenia gravis patients having received glucocorticoid were lower than those in the patients having had no steroid theraphy. ConclusionThe results suggested that there was certain correlation between the increase of GCR values in myasthenia gravis patients and the short term curative effects.