糖皮质激素对重症肌无力患者相关免疫机制影响研究

Impact of glucocorticoid on immunology pathogenesis in patients with myasthenia gravis

目的探讨糖皮质激素(GC)对重症肌无力(MG)患者的免疫调节疗效及机制。方法治疗组34例患者用GC治疗,疗程2个月,观察治疗前后症状改善情况及外周血抗乙酰胆碱受体抗体(AchRAb)、免疫球蛋白及补体的水平。结果经治疗2个月后,治疗组临床总有效率为82%(28/34),治疗前MG患者血清AchRAb、IgG1、IgG3均高于健康组,C3低于健康组,差异均有统计学意义(P<0.05),IgM、IgA和C4、IgG2、IgG4与健康组比较差异均无统计学意义(P>0.05);经2个月治疗,血清AchRAb、IgG1浓度降低、C3浓度升高,较治疗前差异有统计学意义(P<0.01);AchRAb与IgG1在治疗前及治疗后有正相关性,与IgG3、C3无相关性。结论 GC可能通过对体液免疫等功能的影响而发挥治疗作用。

Objective To investigate the impact of glucocorticoid on immunology pathogenesis in patients with myasthenia gravis（MG）.Methods Thirty-four cases of MG in the treated group received glucocorticoid therapy for 2 months.Alterations in symptoms and peripheral blood levels of AchRAb,immunoglobulin and complements were observed before and after treatment.The relationship between AchRAb and the others（IgG1,IgG3,C3） of the patients was analyzed.Results After two months of treatment,total effective rate in the treated group was 82%（28/34）;and serum levels of AchRAb,IgG1,IgG3 were higher in the MG groups than in the healthy group,and C3 levels were lower in the MG groups than in the healthy group（P〈0.05）.No statistical significance was noted in serum levels of IgM,IgA and C4,IgG2,IgG4 between the MG groups and the healthy group（P〈0.05）.After 2 months of treatment,significant differences were noted between before and after treatment in AchRAb,IgG1 and C3 levels of the treated group（P〈0.01）.There was correlation between AchRAb and IgG1,but is was not related to IgG3 and C3 before and after treatment in myasthenia gravis.Conclusions Glucocorticoid might improve the clinical symptoms of MG through modulating humoral immunity functions.