重症肌无力特异性细胞免疫应答

Specifie Cell-Mediated Immune Response in Myasthenia Gravis

目的了解重症肌无力 (MG)特异性细胞免疫应答情况。方法采用酶链免疫吸附试验 (EL ISA)和逆转录 -聚合酶链反应 (RT- PCR)结合狭缝印迹杂交检测 MG患者及健康对照者的 PBMC和胸腺细胞 ACh R刺激后 IFN-γ和 IL - 4的表达及转录 ,并对行胸腺摘除 (Tx)者进行了随访。结果总 MG患者组 PBMC IFN- γ表达高于对照 ,尤以急性 MG更著。增生的胸腺细胞IFN-γ、IL - 4转录和 IL - 4的表达高于对照 ,胸腺细胞和 PBMC的 IL - 4转录明显相关。 Tx 1周后 PBMC IL - 4的表达减少 ,1月后IFN- γ转录下降。结论 MG患者体内存在特异性细胞免疫活化和细胞因子网络的失衡 ,PBMC有些免疫学参数能反映胸腺的免疫学改变 ;胸腺增生和胸腺瘤的 MG发病机制可能不同 ;Tx及其后应用糖皮质类固醇治疗是必要的。

ObjectiveTo explore the specific cell mediated immune response in the patients with myathenia gravis(MG).Methods IFN γ and IL 4 secreted by peripheral blood mononuclear cells(PBMC) and thymocytes in MG patients and healthy controls were determined with ELISA.IFN γ and IL 4 mRNA were detected by reverse transcription polymerase chain reaction(RT PCR) after cultured with the stimulation of human nicontinic acetlcholine receptor.The IFN γ and IL 4 expres sion were monitored in MG patients with Thymectomy(Tx).Results The expression of IFN γ by PBMC was significantly elevated on all MG patients,especially more higher in the acute stage.The transcription of IFN γ and IL 4,IL 4 secretion from thymocytes in MG patients with thymic hyperplasia was high.IL 4 mRNA in thymocytes was well correlated with that in PBMC.IL 4 secretion declined one week after Tx while IFN γ mRNA decreased one month after Tx.Conclusions There was an activation of specific cell mediated immunity and an imbalance of cytokines from Th1 and Th2 in MG patients.Some of the immune parameters in PBMC might reflect the immun alterations in the thymus from MG patients.The immune mechanism of MG patients with hyperplasia is differnet from that with thymoma.Thymectomy followed by treatment with adrenocorticosteroid is necessary for MG patients. [