重症肌无力患者血清抗皮动蛋白抗体的检测及其临床意义

Cortactin antibody in myasthenia gravis and its clinical significance

目的 探讨重症肌无力（myasthenia gravis,MG）患者血清抗皮动蛋白（cortactin）抗体检测的临床意义.方法 用重组纯化人皮动蛋白作为抗原,采用ELISA、Western印迹法对100例贵州医科大学附属医院神经内科2015年6月至2017年6月门诊及住院MG患者（MG组）、40名健康对照者（健康对照组）及40例其他神经免疫疾病患者（OND组）进行血清抗皮动蛋白抗体检测,同时采用ELISA检测MG患者血清中乙酰胆碱受体抗体（AChR-ab）、肌肉特异性酪氨酸激酶抗体（MuSK-ab）水平.结果 MG组共发现抗皮动蛋白抗体阳性患者9例（9％）,其中5例为抗皮动蛋白抗体单阳性,余4例为抗皮动蛋白抗体合并AChR-ab阳性,健康对照组、OND组抗皮动蛋白抗体均为阴性;抗皮动蛋白抗体阳性患者以早发型多见（7/9）;抗皮动蛋白抗体单阳性患者不伴胸腺瘤;4例合并AChR-ab阳性患者Osserman分型重（3例ⅡB型、1例Ⅳ型）,受累肌群多.结论 抗皮动蛋白抗体可能是MG的一种新抗体,可为进一步探讨MG的发病机制提供线索.

Objective To investigate the clinical significance of cortactin antibody in myasthenia gravis （MG）.Methods Cortactin antibody in the serum of 100 MG patients, 40 normal controls and 40 other neuroimmune diseases patients was examined by Western blotting and ELISA using purified recombinant human protein cortactin as antigen .Acetylcholine receptor antibody （ AchR-ab ） and muscle specific kinase antibody （MuSK-ab） were parallely measured by ELISA.Results Antibodies to cortactin were found in nine （9%） serum samples of 100 MG patients.Four of the nine cortactin antibody positive sera were also positive for AChR-ab.The rest five MG patients only had antibodies against cortactin （ no detectable AChR-ab or MuSK-ab）.None of the control subjects （including 40 normal controls and 40 other neuroimmune diseases patients ） had cortactin antibodies.Most （7/9） of the cortactin antibody positive MG patients presented with early-onset subgroup.Patients only with cortactin antibodies did not appear to have thymoma.Patients with MG who had both AChR and cortactin antibodies showed maximum involvement of muscles and severe Osserman＇s classification （ three cases of type ⅡB and one case of type Ⅳ） . Conclusion Cortactin antibody may be a new antibody for MG , which can provide clues for further exploring the potential pathogenic mechanisms of the disease