重症肌无力患者外周血T淋巴细胞亚群分布特点及临床意义

Distribution characteristics of T lymphocyte subsets in the peripheral blood of myasthenia gravis patients and their clinic significance

目的重症肌无力（myasthen ia gravis,MG）是T细胞依赖的、抗体介导的自身免疫性疾病。文中探讨MG患者外周血T细胞亚群分布特点及其与预后的相关性。方法采用流式细胞技术测定例MG患者外周血CD4＋、CD8＋细胞亚群百分比,分析不同年龄、性别、临床分型MG患者外周血T细胞亚群分布特点。随访MG患者经胆碱酯酶抑制剂、糖皮质激素及胸腺扩大切除术3种不同治疗方案后3~14个月的治疗效果,分析MG患者T淋巴细胞亚群异常与其临床转归的相关性。结果与正常对照组相比,MG患者外周血CD8＋T细胞百分比明显降低,CD4＋/CD8＋比值异常升高,2组间CD4＋T细胞百分比无差异。不同性别、临床分型MG患者外周血T细胞亚群分布无明显差异。但随着年龄的增加CD4＋/CD8＋比值升高。仅服用胆碱酯酶抑制剂患者预后与外周血T细胞亚群百分比无关。治疗前患者T细胞亚群紊乱明显,即CD8＋百分比下降、CD4＋/CD8＋比值升高明显者,经糖皮质激素及胸腺扩大切除术疗效较好。结论 MG患者体内存在T淋巴细胞亚群分布异常,且随着年龄的增加越明显,而与性别、临床分型无关。治疗前患者T细胞亚群紊乱者糖皮质激素及胸腺扩大切除术疗效明显。检测外周血T淋巴细胞亚群百分比对于临床指导治疗、判断预后有重要意义。

Objective Myasthenia gravis（MG） is a T cell-dependent antibody-mediated autoimmune disease.In this study,we observed the distribution characteristics of T cell subsets in the peripheral blood and analyzed their corrections with the prognosis of MG. Methods We measured the percentages of CD4＋ and CD8＋T cells by flow cytometry,and compared the distribution characteristics of T cell subsets in MG patients of different ages,sexes and clinical stages.We followed up the patients for 3 to 14 months after treatment with anticholinesterase,corticosteroids or thymectomy,and analyzed the correlation between the distribution of T cell subsets and clinical outcomes.Results The percentage of CD8＋ T cells was significant decreased and the ratio of CD4＋/CD8＋ T cells was increased in the MG group as compared with the controls,but there was no statistically significant difference in the percentage of CD4＋ T cells between the two groups.The abnormalities of T cell subsets in MG showed no correlation with sex and clinical stages,while the ratio of CD4＋/CD8＋T cells rose with the increase of the patients＇ age.The prognosis of MG was not correlated with the percentage of T cell subsets in the peripheral blood of the patients treated with anticholinesterase alone.Corticosteroid medication and thymectomy achieved fairly good results in those with decreased percentage of CD8＋ T cells and increase ratio of CD4＋/CD8＋ cells before treatment.Conclusion There is an abnormal distribution of T cell subsets in MG patients,which becomes more obvious with the increase of age but is not related to the sex of the patients and clinical stages of the disease.Those with abnormality of T cell subsets respond favorably to corticosteroids or thymectomy.Determining the percentage of T cell subsets in the peripheral blood is significant for clinical treatment and outcome evaluation.